A number of Senate Republicans are gathering behind a bipartisan push to shore up the Affordable Care Act, reflecting a growing divide between President Donald Trump and many GOP senators.
Republicans brushed off a call by Mr. Trump to continue working on a repeal of the 2010 health-care law after their bill to roll back and replace it failed by a single vote in the Senate in late July. Mr. Trump has called for letting the ACA implode on its own, and on Thursday the administration cut funding for ads and grants to encourage ACA sign-ups, a move that Democrats said would destabilize insurance markets.
Yet few congressional Republicans have signaled they are ready to let the health-care market deteriorate while their constituents are still battling higher premiums and fewer insurers to choose from on the individual marketplace.
“If I vote for something, and I hold my nose for voting for it, it’s because I want Iowans to be able to buy health insurance,” Sen. Chuck Grassley (R., Iowa) said in Iowa this week. “Something better pass because we in Iowa need to get something for the 72,000 Iowans that can’t get insurance.”
President Donald Trump has been feuding with Senate majority leader Mitch McConnell and other Republican members of Congress in recent weeks. The WSJ’s Gerald F. Seib lays out why Mr. Trump is criticizing members of his own party and examines whether they can patch things up. Photo: Getty
Most attention has focused on a bipartisan plan from Sens. Lamar Alexander (R., Tenn.), chairman of the Senate’s health committee, and Patty Murray of Washington, the committee’s top Democrat, that would likely preserve billions of dollars in federal payments to insurers to help bolster the markets. Republicans are pushing for the plan to include some measures to give states more flexibility or other steps to lower costs.
But even if the health-committee leaders could find 60 votes to move their bill through the Senate, it isn’t clear whether it would receive backing in the House or from the White House. Mr. Trump has kept insurers in suspense over whether he will continue paying cost-sharing reductions to them. Thus far, he has continued the payments each month.
The White House didn’t respond to requests for comment.
The window for Republicans still hoping for a sweeping rollback of the ACA closed further Friday. The Senate parliamentarian said the GOP can only take advantage of a procedural shortcut tied to the fiscal year 2017 budget until Sept. 30, according to a statement from Budget Committee Democrats that wasn’t disputed by Republicans.
That shortcut, known as reconciliation, allows Senate Republicans to pass legislation with a simple majority rather than the usual 60 required to clear procedural hurdles.
The move toward a bipartisan health fix is another indication that more GOP senators are showing they have the willingness to go their own way. Before senators left for their August recess, they approved new sanctions to punish Russia for its alleged interference in the 2016 election, over the objections of the White House. Many Republicans in both chambers condemned white supremacists more forcefully than Mr. Trump did following the violence in Charlottesville, Va. in August, and some criticized the president’s response. Some have also decried his decision last week to pardon former Arizona Sheriff Joe Arpaio, who was convicted in July of violating a 2011 federal court order to stop immigration raids.
Mr. Trump, in turn, has chided Senate Majority Leader Mitch McConnell (R., Ky.) over the health-care effort’s stumbles and took the unusual step of praising a GOP primary challenger to Sen. Jeff Flake (R., Ariz.)
The insurance stabilization bill could be a turning point, some Capitol Hill insiders said. Hill aides from both sides of the aisle said Senate Republicans might break from the president over the legislation.
After the GOP repeal effort fizzled, Mr. Trump tweeted on July 29, “If a new HealthCare bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”
Republicans are supporting the stabilization bill because they realize they will be blamed for higher premiums and other problems on the individual market, Ms. Murray said in an interview Thursday.
“If they own a lot of the destabilization and recognize it and don’t make some policy changes, they will be held responsible for people’s payments,” she said.
The payments to insurers are controversial in the House, where Republicans are split over whether Congress should take the step of authorizing the payments in the absence of any broader health-care overhaul.
“I do not support cost-sharing [payments] as a solution, but as a stopgap measure, until we can get it right and get a real replace out there, I think we have no choice but to support” a one-year funding measure, Rep. Dennis Ross (R., Fla.), a member of the House GOP whip team, said in a recent interview.
But Rep. Mark Walker (R., N.C.), chairman of the Republican Study Committee, a group of more than 150 conservative House Republicans, said many lawmakers in his group would likely balk at approving the payments.
“We are very uncomfortable at considering keeping those. You’re basically bailing out insurance companies,” he said. Most of the RSC lawmakers “have a huge problem with this,” he said.
In the Senate, some Republicans are looking at another plan from Sens. Lindsey Graham (R., S.C.) and Bill Cassidy (R., La.) that would largely topple most of the ACA. That measure risks drawing GOP support away from the stabilization push. The bill would take ACA funding and distribute it to the states through block grants, which Democrats say would cut Medicaid funding.
Lawmakers will have little time to decide how to proceed once they return to Washington next Tuesday.
The Senate GOP push to stabilize the ACA’s markets must happen by the end of September, because insurers must make decisions on premium rates and participation on the exchanges. Insurers have until Sept. 27 to sign federal contracts to offer plans next year.
The money compensates insurers for reducing out-of-pocket costs for some low-income consumers who sign up for plans on the exchanges. About seven million people qualified for the subsidies in 2017.
Premiums for popular, midprice plans on the ACA exchanges would rise 20% next year without the cost-sharing reduction subsidies, according to an August report by the nonpartisan Congressional Budget Office.
Not all see the stabilization bill as a revolt by Republican senators. Some said they see the legislation more as an effort by GOP lawmakers to accomplish something on health policy following the failure of repeal.
“It’s going to be part of an overall discussion,” said Ed Pozzuoli, a Republican strategist and lawyer. “You’re seeing a series of ideas and drive for consensus.”