Republicans face a fresh fight over Obamacare
Moderates want to fix it, conservatives to crush it
WASHINGTON – Congressional Republicans will open their 2018 legislative agenda wrangling over a politically dicey and very familiar issue: Obamacare.
Moderates want to bolster the Affordable Care Act, especially in the face of possible increases in premiums for insurance consumers.
Conservatives want to take another shot at killing the 2010 health care law, even though the GOP’s attempts to do that consumed much of 2017 and ended in failure.
“There are Republicans who are ready to make peace and go forward and those that will never,” said lobbyist Rodney Whitlock, a former Senate GOP health policy staffer.
This time, Republicans will face more pressure to act, especially in the Senate. Senate Majority Leader
Mitch McConnell, R- Ky., promised a key GOP moderate he would push for passage of two bills designed to stabilize Obamacare and keep premiums down in the individual insurance market.
In exchange, Sen. Susan Collins, RMaine, agreed to vote in favor of the GOP tax bill, which passed last month and was signed into law by President Trump.
The tax lawincludes a repeal of the mandate for individuals to obtain health insurance, which was established under the ACA to prompt young, healthy people to purchase insurance, thereby making insurance cheaper for sicker, older Americans.
Without that population in the mix, average premiums would increase by 10% for most years over the next decade, according to an analysis by the Congressional Budget Office. The tax law nixes the mandate starting in 2019.
In addition to the premium increases, the CBO estimated that 13 million Americans would drop off the insurance rolls by 2027 without the mandate in place. Somewould choose not to buy insurance, and others would no longer be able to afford it.
“We must have other health care reforms in place in order to prevent further increases in the cost of health insurance,” said Annie Clark, a spokeswoman for Collins. “Sen. Collins believes that averting these price spikes, particularly for low- income families, should be a goalmembers of both parties can embrace.” Collins pushes two bipartisan bills: One proposal, written by Sens. Lamar Alexander, R- Tenn., and Patty Murray, D- Wash., aims to shore up Obamacare insurance markets. It would guarantee two years of reimbursements to insurance companies for the reduced co- payments and deductibles they are required to provide to low- income consumers.
Trump has halted those subsidy payments, which are worth about $ 7 billion this year.
The Alexander- Murray bill would expand the authority for states to experiment with alternative insurance standards that deviated from the Obamacare minimum requirements.
The second measure, written by Collins and Sen. Bill Nelson, D- Fla., would set aside at least $ 2 billion in a “reinsurance fund” to help states protect health insurers from catastrophic losses sustained from coverage of high- risk patients under the Affordable Care Act.
McConnell originally promised Collins that he would push the two bills through Congress last month. That plan faced stiff opposition in the House of Representatives, where Speaker Paul Ryan, R- Wis., said he was not bound by McConnell’s agreement.
Conservatives in the House are staunchly opposed to any legislation that would prop up Obamacare. They said the Alexander- Murray proposal is a bailout for insurance giants.
Other Republicans said they should turn back to repealing Obamacare altogether and replacing it with a GOP alternative. McConnell suggested he would revisit a repeal- and- replace bill only if he was sure it would pass the Senate — a steep challenge given that Republicans will control only 51 votes in the chamber starting Wednesday, when a newly elected Democrat, Doug Jones of Alabama, is sworn in.
“I’d love to be able to make more substantial changes to Obamacare than we have,” McConnell said at a year- end news conference Dec. 22.
Whether McConnell can convince Ryan to go along with the two Collinsbacked bills is unclear.
The most promising strategy might be to attach the proposals to a spending agreement that lawmakers will take up in the next few weeks.
Funding for the government will run out Jan. 19, so Congress must pass a spending bill before then to avert a shutdown.