Sep 8, 2017

What's next in the Senate's search for an ACA compromise

Caitlin Owens, author of Vitals

AP Photo/Jose Luis Magana

All things considered, the HELP Committee's hearings this week about stabilizing the Affordable Care Act went incredibly well. Republicans, Democrats, senators, governors and insurance commissioners are more or less on the same page. And, miraculously, nearly every member was on their best behavior, avoiding partisan jabs at the health care law or one another.

But it's easy to have a good hearing. There's still a long way to go before the finish line. Here's what's ahead, both short-term and longer term.

Committee: The details will be crucial, but it seems highly likely that HELP Chairman Lamar Alexander and ranking Democrat Patty Murray will be able to pull off an agreement.

  • "I wouldn't bet against Lamar Alexander and Patty Murray," Sen. Michael Bennet told me, a sentiment echoed throughout the committee.
  • The final package is likely to be pretty simple: Funding for cost-sharing reduction subsidies paired with more flexible state innovation waivers. It's looking pretty likely that the subsidies will be funded for two years, in exchange for adding a less comprehensive "copper" plan option for people older than 30.
  • But it's unclear how the process moves forward. Murray said she doesn't know exactly how it's going to play out yet, but a senior GOP aide told me they're skeptical the committee has time to mark up legislation.

Floor: Assuming the committee reaches an agreement, it would seem to stand a good chance of passing — at least in the Senate. The question is when. (The House is a different matter — and President Trump would have to sign it, too.)

Sen. John Thune, a member of Republican leadership, told me a bipartisan solution could "probably" get through the Senate. Alexander and Murray are adamantly pushing to get the bill through the Senate by the end of the month. But there's deep skepticism that Majority Leader Mitch McConnell will bring the bill to the floor this month. There are few must-pass vehicles to attach it to. (Finance Committee Chairman Orrin Hatch doesn't want it attached to CHIP reauthorization). And secondly, there's just not much appetite to revisit health care after the summer's failed repeal-and-replace effort. "Nothing to attach it to so there's no cover," one GOP lobbyist said.If it doesn't pass in September, there's plenty to attach it to later in the year. "Lamar is still very focused on getting something done by the end of the month. If not, we then have plenty of vehicles to get something to the finish line in December," Sen. Chris Murphy said.The future: Alexander has repeatedly characterized the stabilization package as only the committee's first step in reforming the health care system. A surprising number of senators seem to be taking that premise seriously.

Sen. Tim Kaine said he can see some kind of federal reinsurance measure, paired with new ways to get more people into the marketplace, as a natural starting place for the committee's second bite at the apple. Several Democrats even said they'd be willing to look at alternatives to the individual mandate. "I think we're open. There's some principles here about expanding health insurance coverage, making sure it's quality coverage, those are things we feel very strongly about. But we have got to be willing to at least listen to the other side and see if we can find some common ground," Minority Whip Dick Durbin told me.But there are plenty of skeptics. Sen. Rand Paul, who said a stabilization package is likely achievable even though he doesn't support it, told me that "we're too far apart on things" to get anything else done on health care.

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