Now that the GOP’s plan to repeal and replace the Affordable Care Act has stumbled, will Republicans and Democrats work together to shore up the existing law and stabilize the health insurance markets?
Groups like the House’s bipartisan “Problem Solvers” caucus are emerging in both chambers to push a variety of ideas to fix problems with the current health care system, such as rising premiums and increasing out-of-pocket costs. They also may have to fend off a retaliatory move by President Donald Trump to cut the federal funds that finance health care for Congress members and many of their staffers.
Given the failure of sweeping Republican plans, it may seem more attractive to simply pivot away from health care, moving on to tax reform and other legislative priorities.
In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Sarah Kliff of Vox.com and Mary Agnes Carey of Kaiser Health News discuss the various options on Capitol Hill. The transcript below has been condensed and edited for clarity.
JULIE ROVNER: There are various bipartisan groups meeting around the Capitol and elsewhere in Washington and it appears some Republican governors are getting involved. Meanwhile, President Trump is now threatening not only to retaliate against the insurance industry but against the health insurance of members of Congress and some of their staffers. There are also efforts to revive legislation. Is there any chance this results in something that can pass?
SARAH KLIFF: I am skeptical. You never say never, right? I think we’ve all learned that. With the last few months of debate, you really saw the Senate reject not just one health care bill but four health care bills. One option hanging out there is a proposal from Sens. Bill Cassidy of Louisiana and Lindsey Graham from South Carolina that has been getting some traction. It’s been the subject of White House meetings, and the [House GOP] Freedom Caucus is pointing to it as the way forward, but it has not come under much scrutiny.
And I think when people look at it they will find many of the things they did not like about the other proposals. [The measure is] a more severe way to essentially be a block grant, so all of the Obamacare money that is spent on subsidies and on the Medicaid expansion is put into one package. States could decide what to do with it in a way that would disadvantage big urban states and advantage small rural states. I don’t see a path towards that passing.
ROVNER: So, meanwhile, we have this “Problem Solvers” group in the House.
JOANNE KENEN: When I saw that they were calling themselves the Problem Solvers Caucus, it just occurred to me, what does that say about the rest of the people up on Capitol Hill? Are they the “Problem Causers Caucus”? I mean, it’s about 40 Republicans and Democrats. They’ve outlined some stabilization steps similar to what the actuaries and the professionals looking at this would recommend. Does it have traction at this point, at this very moment? No, we’re not ready to go from this heated seven-year repeal fight to, “OK everybody let’s be bipartisan.” I mean, that’s not flipping a switch. That’s a process.
ROVNER: I want to talk about the president for a minute, because as we know every time a legislative effort has flagged, President Trump has threatened to withhold payments to insurers to reimburse them for the cost-sharing discounts they have to give to lower-income enrollees. Do you think he might actually follow through this time, and what impact could that have?
KLIFF: I think just the threat is having a big impact. Insurance companies have to file their rates for the Affordable Care Act marketplaces on Aug. 16. And most of the ones I’ve talked to have said if we don’t have a guarantee that they plan to pay this, we’re just going to price as if they’re not there, which means, like, 15 [percent] to 20 percent higher rates.
MARY AGNES CAREY: You have Republicans that want the president to continue funding the subsidies. They don’t want to take the political hit [if the cost-sharing subsidies are discontinued]. That will obviously happen if you don’t continue those subsidies and if health plan rates are jacked up 20 percent. There’s a lot of political peril in this for Republicans and for President Trump.
ROVNER: September is going to be a mess. There are deadlines for funding bills with the federal debt ceiling, which has to be raised. And also a bunch of health issues, including the Children’s Health Insurance Program and authority for the FDA [Food and Drug Administration] to keep collecting industry fees to keep the programs running. So, why don’t we handicap the chances of what’s going to happen in September when it comes to health care?
KENEN: [The Senate] could do the FDA user fees this week or next. It’s already gone through the House. It is possible. We’ll see what happens.
CAREY: The Children’s Health Insurance Program has wide bipartisan support and has to be reauthorized by the end of September. It helps families whose incomes are a little bit higher than those who qualify for Medicaid get health insurance. That’s another pressure point. If [for] some reason by the end of September there was some deal on the health reform, they could stick on [the CHIP reauthorization] and see what happens.