GOP senators weigh slower repeal process for Obamacare

Senate Republicans are weighing a two-step process to replace Obamacare that would postpone a repeal until 2020, as they seek to draft a more modest version than a House plan that nonpartisan analysts said would undermine some insurance markets.

Republicans — in the early stages of private talks on the Senate plan — say they may first take action to stabilize premium costs in Obamacare’s insurancepurchasing exchanges in 2018 and 2019. Major insurers have said they will leave the individual market in vast regions of states including North Dakota, Iowa and Missouri.

A Senate plan is likely to continue subsidies that help low-income Americans with co-pays and deductibles, said Republican John Thune of South Dakota. White House budget director Mick Mulvaney said Thursday the administration hasn’t committed to paying subsidies due in June, which creates additional uncertainty for insurers as they set rates for next year.

“There clearly has to be a short-term solution that works with the transition until some of our long-term policy changes can take effect,” Thune told reporters. “There’s got to be certainty in the marketplace.”

The private Senate GOP negotiations include a 13member leadership-controlled working group as well as almost daily closeddoor discussions among all Senate Republicans. In addition, Republican Sen. Susan Collins of Maine has convened bipartisan talks with about a dozen senators.

Republicans in the Senate are stepping up their efforts to build consensus after the nonpartisan Congressional Budget Office Budget director Mick Mulvaney says the White House hasn’t committed to paying ACA subsidies due in June. said Wednesday that the House plan narrowly passed May 4 would result in 23 million more people without insurance and, in some states, plans that are too costly for older or sicker people.

Democrats in both chambers are united against efforts to replace the 2010 Affordable Care Act and said Wednesday that the CBO assessment provides added ammunition for the Senate fight. Senate Minority Leader Chuck Schumer of New York said the report should be the “final nail in the coffin” in the Republican drive to end Obamacare.

Senate Republican leaders say they expect to try to pass a bill with only GOP votes. The party controls the Senate 52-48, and the parliamentarian will determine which parts of a bill could advance under streamlined procedures that can pass with 50 votes plus Vice President Mike Pence’s tie-breaker.

Senators have indicated that the talks have spent little time on perhaps the toughest issue: How to pay for a plan that would cover more people and offer lower premiums than the House bill. That would require retaining some of about $800 billion in Obamacare taxes that the House measure repeals or finding other cost savings in the federal budget.

The subsidies for lowincome insurance customers total about $7 billion a year. Blue Cross Blue Shield of North Carolina filed Thursday to raise its rates on average by 22.9 percent next year — but if the subsidies were funded, the increase would be 8.8 percent, according to Brian Tajlili, the insurer’s head of actuarial and pricing services.

The health insurer has seen results from Obamacare plans improve markedly after raising rates, but the uncertainty from Washington is threatening those gains. “We’re seeing the market begin to stabilize after three years of coverage,” Tajlili said in a statement.

Senate Republicans say there is a growing consensus that they want a slower phase-out of Obamacare’s expansion of Medicaid health coverage for the poor than in the House bill, which would cut the program by about $800 billion. Senators from states that elected to take advantage of the Medicaid expansion want a several-year phaseout to avoid a “cliff” that would occur if the expansion ended in 2020 as the House bill reqiuires.

Republican Sen. John Hoeven of North Dakota said the longer phase-out has some support.