Bipartisan health law bid faces hurdles
Short time frame, block grant plan could hinder fight to cut premiums
USA TODAY WASHINGTON Sen. Lamar Alexander acknowledged the obvious when he opened a series of hearings last week that he hopes will result in a bipartisan plan to lower health insurance premiums for millions of Americans.
“Timing is a challenge,” the Tennessee Republican conceded, pointing out that lawmakers will have to act quickly because insurers must have their 2018 rates ready by the end of the month.
But the calendar is far from the only obstacle senators face in their push to end a seven-year stalemate on health care and inject stability into the individual insurance market after the collapse of GOP efforts to repeal the Affordable Care Act.
Alexander, who chairs the Senate Health, Education, Labor and Pensions Committee, is leading the bipartisan march with the committee’s top Democrat, Sen. Patty Murray of Washington.
They are aiming for a limited, short-term fix that can provide relief from higher premiums for 18 million Americans who don’t have employer-based insurance but instead buy individual coverage on one of the marketplaces created by the Affordable Care Act, or Obamacare.
But competing legislation also is in the works.
Republican Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana and Dean Heller of Nevada are expected to unveil a plan this week that would give states block grants to design their own health insurance systems. The senators say that if states want to keep their Obamacare programs, they can, and if they want to repeal and use a new system, they can do that, too.
The measure appears to be gaining momentum among Republicans and could complicate Alexander and Murray’s push for a short-term fix for the individual market, which has seen an exodus of insurers and large premium increases under Obamacare.
Sen. John McCain, the Arizona Republican who cast the critical vote that killed the Senate’s bid to repeal Obamacare in late July, said he likes the block-grant proposal but would have to see the final version before agreeing to support it.
The White House also has signaled that President Trump would sign the bill if it landed on his desk.
Even if Alexander and Murray were able to craft a bipartisan bill that could pass the Senate, they’d still have to get it through the House, which is a higher hurdle.
House conservatives are still holding out hope that the Affordable Care Act can be repealed. The conservative House Freedom Caucus has filed a petition to force a vote on an Obamacare repeal bill that passed Congress in 2015 but was vetoed by thenPresident Obama.
Some House Republicans also have shown more interest in the block-grant bill than in Alexander and Murray’s attempts at a shortterm fix.
While Alexander and Murray are stressing a unified approach, some partisan divisions were still obvious at last week’s hearings.
Several Democratic senators, including Elizabeth Warren of Massachusetts and Tammy Baldwin of Wisconsin, accused Trump of trying to sabotage the Affordable Care Act by slashing funding used to promote enrollment and pay “navigators” who help consumers choose an insurance plan.
Sen. Rand Paul, R-Ky., suggested that the individual market doesn’t work and that, rather than trying to fix it, lawmakers should focus on providing other ways for consumers to purchase insurance, such as association health plans that allow small businesses or groups to band together to buy coverage.
“Let’s try to give people an exit ramp to get out of the individual market completely,” he said.
Despite those headwinds, Alexander and Murray remain optimistic about their efforts.
“I think everyone is looking for a result,” Alexander said Thursday after the close of the second of four hearings his committee has scheduled on the matter.
Before the first hearing, which was held Wednesday and featured testimony from top insurance regulators from five states, Alexander held a private meeting between the witnesses and lawmakers to talk about how a consensus can be reached. Thirty-one senators showed up. Two days later, 30 senators attended a private meeting with five governors before they appeared before the panel.
Alexander described the conversations as constructive and said they indicated broad interest in achieving a result.
Murray also was hopeful that a bipartisan deal could be reached to stabilize markets and lower insurance costs.
“Many Democrats and Republicans agree on ... this specific goal,” she said.
Alexander is pushing to have a bill ready by the end of this week. The legislation likely will focus on improving Obamacare’s waiver process so that states will have more flexibility to design and regulate insurance plans.
The proposal is also expected to continue the federal cost-sharing funding that enables insurers to provide affordable coverage for low- and moderate-income families.
The state insurance regulators and governors recommended both steps during last week’s hearings. They urged senators to continue the cost-sharing funding for another two or three years, if not permanently. Alexander favors extending it for another year but has indicated he is keeping an open mind.
“The reason for the hearings is for me to learn and listen,” he said. “I’m going to sit down with Sen. Murray and with other senators and come to a conclusion about what I think we can pass. That will affect my decision.”
The final two hearings are scheduled for this week.