Sep 15, 2017

Lamar Alexander's ACA balancing act

Sens. Lamar Alexander and Patty Murray are trying to find an ACA compromise, (AP Photo/Alex Brandon, File)

Senate HELP Committee Chairman Lamar Alexander is trying to thread a very thin needle as he searches for a bipartisan bill stabilizing the Affordable Care Act's insurance markets. He's under pressure from all sides, but almost everyone agrees: If anyone is going to figure out how to solve this, it's him.

  • "Lamar is the perfect person to be in the position that he's in," Sen. Jerry Moran told me.

Yes, but: As Sen. Roy Blunt told me, "He's very capable and he's good at trying to find a rational argument on how to get something done. But this is a hard assignment, so we'll see how he and Sen. [Patty] Murray do."

Alexander has tried to carve out a narrow middle ground in a debate that has never really had one. Here's why it's so hard, and where the competing pressures are coming from:

  • The right: Several Republicans, including Finance Committee Chairman Orrin Hatch, quickly criticized the prospect of funding the ACA's cost-sharing subsidies as an "Obamacare bailout." Republicans are not going to readily vote to prop up a law they've spent years attacking, unless they get some real concessions. "Trying to get people to think about this outside of just the collapsing failure that many of us see in Obamacare is hard to do. And I think to get very many votes on the Republican side, you'd have to have a bill that arguably creates a lot more flexibility for governors and states," Blunt said.
  • The left: It's easy for Democrats to support funding the cost-sharing subsidies. But Alexander must convince them to get on board with more flexibility to the states — which and that would likely mean softening some of the ACA's insurance regulations, which Democrats don't want to do.
  • The real world: Insurers have proposed double-digit premium hikes; dozens of counties might not have any insurance plans available next year; and many more counties will only have one insurer. If Congress doesn't act, real people will get hurt."I don't think the question is what kind of challenge you face doing it. I think if you do nothing…you have a mad electorate who's mad at us not doing anything. I don't think we have any option," Sen. Johnny Isakson told me.
  • The clock: Insurers must decide by Sept. 27 whether to participate in the exchanges next year. That leaves Alexander very little time to act.

What Alexander says: "If it's balanced, I think I can persuade enough Republicans to support it. This is the kind of proposal where it will have to get a good number of Democrats and a good number of Republicans. It's not like it'll be one-sided."

The strategy: Alexander and Sen. Patty Murray, the top Democrat on HELP, have kept the discussion narrow, and brought in senators outside their committee at the beginning of the process. One of those senators, Sen. Angus King, said Alexander and Murray have handled this difficult task "just the right way."

  • "Lamar's really smart, really smart, he has great people around him, he has a great demeanor about him, and he has a great partner in Patty Murray," Sen. Tom Carper said.

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  1. Global: Total confirmed cases as of 3 a.m. ET: 665,164 — Total deaths: 30,852 — Total recoveries: 140,225.
  2. U.S.: Leads the world in cases. Total confirmed cases as of 3 a.m. ET: 124,665 — Total deaths: 2,191 — Total recoveries: 1,095.
  3. Federal government latest: President Trump announces new travel advisories for New York, New Jersey and Connecticut, but rules out quarantine enforcement. Per the CDC, residents of those states must now "refrain from non-essential domestic travel for 14 days," with the exception of critical infrastructure industry workers.
  4. State updates: Alaska is latest state to issue a stay-at-home order — New York is trying to nearly triple its hospital capacity in less than a month and has moved its presidential primary to June 23. Some Midwestern swing voters who backed Trump's handling of the virus less than two weeks ago are balking at his call for the U.S. to be "opened up" by Easter.
  5. World updates: In Spain, over 1,400 people were confirmed dead between Thursday to Saturday.
  6. 🚀 Space updates: OneWeb filed for bankruptcy amid the novel coronavirus pandemic.
  7. Hollywood: Tom Hanks and Rita Wilson have returned to U.S. after being treated for coronavirus.
  8. What should I do? Answers about the virus from Axios expertsWhat to know about social distancingQ&A: Minimizing your coronavirus risk
  9. Other resources: CDC on how to avoid the virus, what to do if you get it.

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Coronavirus updates: Global death toll tops 30,000

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The big picture: The number of deaths from COVID-19 in the U.S. surpassed 2,000 on Saturday. The United States leads the world in confirmed coronavirus infections — more than 124,000 by early Sunday. The number of those recovered from the virus in the U.S. passed the 1,000-mark on Saturday evening.

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