Senate GOP Leaders Push for Health-Care Effort After House Plan Implodes

  • Moderates see chance to pick up pieces after House implosion
  • Democrats insist Republicans drop dreams of Obamacare repeal

Senate Republican leaders are pushing for a bipartisan health-care effort after the implosion of the House GOP’s Obamacare repeal legislation, but Democrats remain wary.

"I think that’s the lesson of last week -- that it needs to be done on a bipartisan basis, and so we’re happy to work on it with Democrats if we can find any who are willing to do so rather than those who just want to stand back and enjoy the show," said the Senate’s No. 2 Republican, John Cornyn of Texas.

Cornyn took the Senate floor to call out Democrats who have acknowledged flaws with the law in hopes they will now come forward with proposals to overhaul it.

It’s not clear whether Democrats, who largely sat back and let the repeal effort collapse on its own, have much incentive to negotiate yet.

Senate Minority Leader Chuck Schumer of New York has said his party is willing to discuss improvements to the law, but only if Republicans drop their seven-year-long dream of repealing it. 

He urged Trump to immediately cease all efforts to undermine the law. "People’s lives are at stake," he said on the Senate floor Monday. "The president should not hope that the health-care system for tens of millions explodes."

Obamacare ‘Will Explode’

But Trump has said that Obamacare “soon will explode,” while conservatives insist they will continue to push for a complete repeal.

Senator Bill Cassidy, who served as a doctor for decades in a charity hospital, hopes his colleagues take another look at the plan he wrote with Susan Collins of Maine as the answer for a struggling president who just watched one of his top priorities get vaporized by his own backers.

"We can’t pass anything, I think, without Democratic votes," Cassidy said in an interview Monday.

Cassidy acknowledges that Democrats remain wary of GOP efforts to overhaul the law, but the Louisiana Republican thinks they will engage later this year.

"A lot of states represented by Democrats will have double-digit premium increases," Cassidy said. "It isn’t as if the issue is going away," he added, with people who make too much to qualify for subsidies angry about paying tens of thousands of dollars in premiums for plans with high deductibles and few or no choices of plans in many states.

Payments to Insurers

Those increases could soar even faster if the Trump administration ends some payments to insurance companies that have been criticized by Republicans as outside the letter of the law.

"Do you really think the Trump administration will spend billions to bail out insurance companies to maintain Obamacare?" he asked. "I don’t see how we don’t have to come back to this."

But Republicans remain deeply split on how to approach an overhaul of the health-care law, with a conservative wing continuing to demand something closer to total repeal but without the votes to do so.

Senate Republicans had planned to try to slam through passage of House Speaker Paul Ryan’s measure this week if the House had passed it. But more than enough conservative and moderate senators demanding major changes had already come out against it to kill it.

That lack of consensus will likely put the issue on the back burner for a while, while Health and Human Services Secretary Tom Price works to make regulatory changes aimed at dismantling parts of Obamacare.

‘Access That’s Better’

"I think the most promising thing in the near term is to see what Dr. Price can do with what was gonna be Step 2, and see what we can do there to try and restore a market that works and access that’s better," said Senator Roy Blunt of Missouri, a member of the party leadership. "My guess is there will be no rushing to get back to Step 1."

Lindsey Graham of South Carolina, a cosponsor of the Cassidy-Collins bill, didn’t lament the House bill’s demise. "I think this is a short-term setback, good for the country long term," he said, if it leads to a bipartisan deal. "It’ll be a better product."

A new willingness on the part of the White House and senators to reach across the aisle, however, could give new life to the Cassidy-Collins effort, which has attracted four additional Republican co-sponsors.

Senator Chuck Grassley of Iowa, a senior member of the Finance Committee, tweeted Friday that Republicans should ditch efforts for a partisan Obamacare rewrite.

"House withdrawal of Obamacare repeal will bring attention to Cassidy/Collins Senate bill," he tweeted, noting they have worked hard to sell it to both parties. "CHECK IT OUT."

Mandates for Coverage

Cassidy has repeatedly said his plan is the only one on the table that could meet the president’s goals of replacing Obamacare with a plan that eliminates mandates for coverage while potentially insuring more people with lower premiums.

Other senators have also said they hope to see a consensus effort emerge, including Tom Cotton of Arkansas, who said on CBS’s "Face the Nation" on Sunday that Congress must revisit health care.

"Later this year, we have must-pass health-care legislation that is coming up, the Children’s Health Insurance Program. It is very important to a lot of Democrats. By that point, I hope that we can reach some kind of consensus where we can try to do away with the worst problems of Obamacare that can only be addressed by legislation," Collins said.

The Cassidy-Collins bill, meanwhile, has been pilloried by conservatives because it keeps in place most of the Affordable Care Act’s taxes and offers a key concession to Democrats: It allows states to retain Obamacare if they want to.

New State Option

States would get a new option for a more flexible marketplace and a plan to replace mandates to buy coverage with the ability of states to auto-enroll eligible people in insurance plans unless they opt out.

Because their plan keeps most of the Affordable Care Act’s revenue -- rather than the House bill’s $1 trillion tax cut -- Cassidy and Collins can offer individuals and states a more generous alternative.

Cassidy and some other moderates had argued in January against repealing all of Obamacare’s taxes, saying that would make it impossible to craft a replacement that would actually meet Trump’s goals of covering more people while cutting their premiums and keeping popular insurance protections like a ban on pre-existing conditions.

The Congressional Budget Office score showing 24 million people would lose insurance by 2026 under the House bill -- breaking Trump’s promise that "everybody" would have affordable insurance -- hurt it with party moderates.

Cassidy and Collins would also keep some of the insurance provisions from the Affordable Care Act, including requirements for mental health and substance abuse coverage.

‘Obamacare Lite’

Keeping those insurance regulations would cause trouble with the party’s right flank, which already labeled the House’s far skimpier tax credits as "Obamacare Lite." The House Freedom Caucus won a late concession last week ending the essential benefits mandate of the law, but most refused to vote for the bill anyway because they wanted to roll back other insurance mandates.

But keeping those protections would be the bare minimum if Republicans want to negotiate with Democrats.

There’s still no guarantee they could win over Democratic senators, although a few, including West Virginia Senator Joe Manchin, have been taking a look at their plan.

Schumer slammed Cassidy-Collins shortly after the bill was introduced in January, calling the proposal "an empty facade that would create chaos -- not care -- for millions of Americans."

Full Repeal

The party’s conservative Senate trio of Rand Paul of Kentucky, Mike Lee of Utah and Ted Cruz of Texas -- each of whom had rejected the House bill for not repealing enough of Obamacare and not cutting premiums -- have still held out hope of passing a full repeal, even as Trump sounded ready to move on.

Other senators, like Health, Education, Labor and Pensions Chairman Lamar Alexander of Tennessee, still say there’s an urgency to act.

Alexander said 230,000 people in his state on the Affordable Care Act exchanges are at risk of losing any access to insurance.

"Unless Congress and the president act soon, these Tennesseans — some of the most vulnerable citizens in our state — are likely to have zero choices of insurance in 2018," he said.

    Before it's here, it's on the Bloomberg Terminal.