Republicans are leaving Washington Thursday for a month of recess with no clear direction on what they’ll do next on Obamacare.
Senate leaders want to just drop the issue altogether. Conservatives say they’re still fighting for repeal. Moderates want to launch a bipartisan effort to fix the shaky Obamacare system.
The reality is that, after seven years of unity on repealing Obamacare, Republicans are rudderless on how to talk about or address the defining domestic policy issue of nearly the past decade for their party, and they have no clear plans despite holding all the levers of power in Washington. Now, they face a month away from the Capitol, answering to their home-state voters about their lack of progress.
“I still think something gets through, just because there’s families that are not going to be able to afford their insurance, middle-income families,” said Sen. Bill Cassidy (R-La.). “It’s going to be a lot of effort.”
Robert Laszewski, an insurance industry consultant, thinks Republicans may find their footing. “Things get done in Washington, D.C., when they have to get done,” he said. “I don’t think this is over. They’re going to get yelled at when they got home for being incompetent, for embarrassing themselves.”
The August recess will mark the first time lawmakers have been home for an extended period since the repeal effort collapsed in the Senate. After seven years of campaigning against the law, this break marks the first time in nearly a decade that the GOP hasn’t aligned its talking points against the Affordable Care Act. Several Republican lawmakers, most House members, have planned town hall meetings, meaning they’re unlikely to be able to avoid the subject.
“Our focus should be on honoring our promise to repeal Obamacare and to lower premiums,” said Sen. Ted Cruz (R-Texas). “Under Obamacare the profits of the 10 largest insurance companies have doubled. The insurance companies are making out like bandits, yet Senate Democrats want to give them billions more in taxpayer money. We should be working for the American people, not for the giant health care companies.”
President Donald Trump wants to keep the focus on repeal, too. He has continued to hammer Republicans for not following through on their promise to scrap the law, which will make it hard to move on to other priorities, particularly tax reform.
The looming open-enrollment season for Obamacare is also likely to keep health care on the front burner. Insurers must finalize rates in the next month, with many seeking premium increases in excess of 20 percent. Republicans routinely pilloried Democrats for such rate hikes in the past, and used lower premiums as justification for overhauling health care system.
Now, they’re in the uncomfortable position of having to explain inaction as millions of Americans again get hit with sticker shock.
When Republicans return from recess they’ll face a packed to-do list that will make it difficult to focus on health care exclusively. Congress will have to raise the debt limit and funding the government by the end of September, as well as reauthorizing the Children’s Health Insurance Program.
The various Obamacare proposals could gain or lose momentum over recess. The Congressional Budget Office is expected to score key Obamacare proposals, including Cruz’s amendment to allow states to waive certain Obamacare consumer protections; Ohio Sen. Rob Portman‘s proposal to help people who gained coverage under Obamacare’s Medicaid expansion buy private insurance; and a plan from Sens. Lindsey Graham of South Carolina and Cassidy that would keep many of Obamacare’s taxes but allow states to decide how to spend the money. Even Sen. Rand Paul (R-Ky.) says he is working on advancing his idea to allow small businesses to band together and offer employee coverage through the small group market.
Looming over it all is the unpredictable Trump. He has repeatedly threatened to scrap crucial cost-sharing subsidies — estimated to be $7 billion this year — that insurers rely on to lower out-of-pocket costs for low-income Obamacare customers.
If that funding goes away, it could tip the insurance markets into chaos. Health plans would likely jack up premiums by around 20 percent or bolt the markets altogether.
There are already 19 counties at risk of having no insurer willing to sell ACA coverage for 2018. If those bare counties proliferate across the country, and tens of thousands of Americans have no access to coverage, it would intensify pressure for congressional action.
But if Trump unilaterally eliminates the subsidies, it would also enrage Democrats, who would view it as an act of sabotage. That would douse prospects for bipartisan work on health care for the foreseeable future.
Despite the tenuous situation, most lawmakers remain optimistic they’ll reach agreement on repealing and replacing Obamacare.
“Whatever we get 50 votes for,” said Sen. John Barrasso (R-Wyo.), “we’re going to be ready to vote on immediately.”
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