Prospects for bipartisanship rise as ACA repeal teeters

WASHINGTON — With his bill to repeal the Affordable Care Act in deep trouble, Sen. Mitch McConnell, the Senate majority leader, raised an alternate possibility on Tuesday evening: Either Republicans come together in the days ahead, or he may have to work with Democrats to shore up the deteriorating health law.

That raised a tantalizing prospect: bipartisanship.

The idea is not that far-fetched. For years, Republicans and Democrats have explored avenues for changing or improving former President Barack Obama’s health care law, from modest tweaks like raising the size threshold at which businesses must offer their employees health insurance to larger revisions involving how the marketplaces created under the act operate.

McConnell had hoped the Senate would pass the repeal bill this week, but he met resistance from moderate and conservative members of his caucus. He spent much of his time on Wednesday in discussions with Republican senators, seeking agreement on the substance of a revised bill.

Republican senators said that McConnell wanted to finish work on the legislation by Friday, submit it for analysis by the Congressional Budget Office and then press the Senate to take it up after

a weeklong break for the Fourth of July.

“I think it’s going to be very difficult” for Republicans to reach agreement on a bill this week, said Sen. Susan Collins, R-Maine. But, she added, “you never know.”

Sen. John McCain, R-Ariz., was even more skeptical. “Pigs could fly,” he said.

Republicans have talked for months about possible ways to repair the Affordable Care Act, although they would clearly prefer the wholesale replacement they have long promised.

Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health Committee, has said he would like to draft legislation geared toward stabilizing the marketplaces and providing a temporary continuation of subsidies paid to insurance companies to offset out-of-pocket medical expenses.

Just this week, Collins, in announcing her opposition to the proposed Republican health care bill, said she wanted to work with members of both parties to “fix the flaws in” the Affordable Care Act.

Last month, senators from both parties met privately to hash out health care issues. The Democrats attending the session included Joe Donnelly of Indiana, Heidi Heitkamp of North Dakota and Joe Manchin III of West Virginia. Among the Republicans were Shelley Moore Capito of West Virginia, Bill Cassidy of Louisiana, Lindsey Graham of South Carolina and Collins.

But any change to the existing law is likely to require McConnell’s participation — and House Speaker Paul Ryan’s consent. Before that happens, an all-Republican effort to repeal the health law may have to die a public death.

On Wednesday, Sen. Chuck Schumer of New York, the Senate Democratic leader, reminded his colleagues of the daylong gathering in 2010 at Blair House, across from the White House, where Obama discussed health care specifics with Republicans shortly before passage of the Affordable Care Act.

“President Trump, I challenge you to invite us — all 100 of us, Republican and Democrat — to Blair House to discuss a new bipartisan way forward on health care in front of all the American people,” Schumer said. “It would focus about what you, Mr. President, have talked about in your campaign: lower costs, better health care, ‘covering everybody’ — not on tax cuts for the rich, not on slashing Medicaid.”

President Donald Trump predicted on Wednesday that “a great, great surprise” would emerge from the Republican health care talks, and he did not take the bait from Schumer.

“He’s done a lot of talking, bad talking, and he just doesn’t seem like a serious person,” the president said of the Senate minority leader.

Money is often the lubricant for legislation, and because the Senate’s health bill includes about $200 billion more in deficit reduction over 10 years than the House version, McConnell has billions of dollars that he could use to address concerns expressed by members of his caucus. Various Republican senators are seeking funds to combat the nation’s opioid epidemic, stabilize health insurance markets, help older Americans pay for health coverage and slow the pace of planned cutbacks to Medicaid.

But pouring more money into the bill to please some senators could infuriate others.

Some of the Senate’s most conservative members have radically different priorities. In a letter to McConnell, outlining changes he wanted to see, Sen. Rand Paul, R-Ky., complained that the bill included $136 billion in assistance for insurers — what he called “insurance company bailouts.”

Another conservative, Sen. Mike Lee, R-Utah, wants to give states even more latitude to modify federal insurance regulations, so that insurers could charge higher premiums for people based on their health status. But making such a change risks inflaming Republicans who want to keep protections for people with pre-existing medical conditions, a key difference between the Senate bill and the one passed by the House last month.

The deep divisions could elevate McConnell’s bipartisan fallback from a political threat leveled to get his troops in line to a legislative reality.

While Trump has blustered about letting the Affordable Care Act “crash and burn,” senators from both parties have expressed deep misgivings about the potential for chaos in insurance markets in some states. Leading lawmakers have said that Congress should provide money for the so-called cost-sharing subsidies paid to insurers so they can reduce deductibles and other outof-pocket expenses for low-income people.

The Senate bill would continue the payments through 2019. Trump has repeatedly threatened to stop the payments to force Democrats to negotiate with him over the Affordable Care Act’s future.

Lawmakers have also offered proposals to address the possibility that consumers in some counties will be left without any insurers offering coverage in their Affordable Care Act marketplace.

Alexander and Sen. Bob Corker, R-Tenn., have proposed allowing consumers in such areas to use federal tax credits to help pay for policies obtained outside the law’s marketplaces.

Democrats and Republicans could also conceivably work together on ways to rein in drug prices and help small businesses with employee health costs.

The overtures have begun — tentatively. Sen. Thomas Carper, D-Del., said that in emails, text messages, phone calls and occasional meetings, he had been “reaching out to Republicans who would like to find a principled compromise to fix what needs to be fixed in the Affordable Care Act.”