Five tough decisions for the GOP on healthcare – The Hill

Republicans have left Washington for the August recess with healthcare decisions hanging overhead, many of which must be addressed by the end of September.

Here are five decisions looming for the GOP.

  1. Should there be one more effort at ObamaCare repeal?

While the GOP attempt at repealing ObamaCare has stalled for now, some in the party are not giving up.

“This ain’t over by a long shot … we won’t rest until we end the ObamaCare nightmare once and for all,” Vice President Pence said at the Tennessee GOP 2017 Statesmen’s Dinner Thursday, according to a pool report.

Yet Republicans are running out of time to take action, as the legislative vehicle they were using to gut the healthcare law and avoid a Democratic filibuster expires at the end of September.

Sens. Lindsey GrahamLindsey GrahamGraham opposes measure to cut legal immigration The Hill’s 12:30 Report Trump, GOP senators unveil measure to cut legal immigration MORE (R-S.C.) and Bill Cassidy (R-La.) are pushing a new plan to redirect money currently spent on providing coverage through ObamaCare and instead give it to states to spend as they choose. 

They have been meeting with White House officials, who are also pushing Congress not to give up on repeal.

“I hope that our leadership will pay attention to this effort, because the idea of leaving ObamaCare without a replacement is pretty naive,” Graham said this week.

Still, Senate GOP leadership has largely signaled they are moving on from repeal for now, with the legislative session in September likely to be dominated by work on funding the government and raising the debt ceiling. 

And there are so far no signs that any of the three GOP “no” votes who sunk repeal, Sens. Lisa MurkowskiLisa MurkowskiMcCain expects to return to Senate next month McCain: Arizona was about to get ‘screwed’ by GOP healthcare plan Trump, GOP senators unveil measure to cut legal immigration MORE (Alaska), Susan CollinsSusan CollinsMcCain expects to return to Senate next month GOP senators pitch rules change amid nominations backlog McCain: Arizona was about to get ‘screwed’ by GOP healthcare plan MORE (Maine) and John McCainJohn McCainMcCain expects to return to Senate next month Overnight Healthcare: Governors press Trump to make ObamaCare payments McCain: Trump’s concerns with Russia sanctions bill ‘misplaced’ MORE (Ariz.), are changing their minds.

However, Graham said he is working with conservative Sens. Mike LeeMike LeeDigital privacy bill still abandons probable cause for our papers McConnell faces questions, but no test to his leadership Overnight Cybersecurity: Senate sends Russia sanctions bill to Trump | Senators unveil email privacy bill | Russia tried to spy on Macron with Facebook MORE (R-Utah) and Ted CruzTed CruzThune: Debt ceiling action ‘unlikely’ before September Republicans wonder: Can we govern? GOP chairman opens door to Democrats on ObamaCare MORE (R-Texas) to try to incorporate their ideas on repealing ObamaCare regulations into his plan.

And Senate Majority Leader Mitch McConnellMitch McConnellOvernight Finance: Trump signs Russia sanctions bill, rips Congress | Trump plan would cut legal immigration | Senate confirms labor board pick | House Budget chair running for governor | Regulator takes step to change ‘Volcker Rule’ House Dem on Statue of Liberty: ‘She persisted’ Senate GOP eyes end to August session MORE (R-Ky.) left the door open to bringing repeal back in some form, noting the fast-track procedure being used to avoid a filibuster had not expired. 

“There’s still an opportunity to do that,” he said.

  1. Should we work with Democrats?

Lawmakers are ramping up bipartisan talks on the next steps for healthcare legislation, some more enthusiastically than others.

Sen. Mike Rounds (R-S.D.) said that following the failure of the Senate GOP’s ObamaCare repeal vote, Democrats have been more willing to talk with Republicans about ways to fix the law.

“Both sides are moving a little bit more to the middle,” Rounds said. “The discussions I’m having have been positive with Democrats, saying, ‘Look, we are open to these changes, we will listen, we will work with you.’”

Sen. Roy BluntRoy BluntDeVos abandons student loan servicing overhaul McConnell leaves door open for second try on healthcare Senate Republicans brush off Trump’s healthcare demands MORE (R-Mo.), a member of the GOP leadership, told The Hill he still wants to repeal ObamaCare “and start over, but that doesn’t mean an effort to hold up the collapsing structure in the short term isn’t the right thing to do.”

Both the Senate’s Health and Finance committees plan to hold bipartisan hearings in September when lawmakers return from recess.

Sen. Lamar AlexanderLamar AlexanderSenate confirms controversial Trump pick to labor board McCain: Arizona was about to get ‘screwed’ by GOP healthcare plan Court rules allowing Dem states to defend ObamaCare payments MORE (R-Tenn.) — the chairman of the Health Committee — said the goal is for the panel to craft a bipartisan, short-term proposal by mid-September, as insurers must sign contracts saying they’ll sell plans on the federal exchange by the end of that month.

Finance Committee Chairman Orrin HatchOrrin HatchOvernight Finance: Trump signs Russia sanctions bill, rips Congress | Trump plan would cut legal immigration | Senate confirms labor board pick | House Budget chair running for governor | Regulator takes step to change ‘Volcker Rule’ Freedom Caucus chairman wants corporate tax rate in the teens Thune: Debt ceiling action ‘unlikely’ before September MORE (R-Utah) did not suggest the panel would produce legislation, but he said there was bipartisan interest in a hearing.

“We’ve also heard a lot of demands from members of the committee for a healthcare hearing. I intend to do that as well shortly after the recess,” Hatch said Thursday. 

But it’s not clear that the renewed interest in bipartisanship will yield legislation.

Alexander’s committee runs the ideological gamut from conservative Sen. Rand PaulRand PaulWhen financial transparency becomes personal tyranny Senate GOP eyes end to August session Turning the power of Big Insurance on its head with the power of the group MORE (R-Ky.) to progressive Sens. Elizabeth WarrenElizabeth WarrenOvernight Finance: Trump signs Russia sanctions bill, rips Congress | Trump plan would cut legal immigration | Senate confirms labor board pick | House Budget chair running for governor | Regulator takes step to change ‘Volcker Rule’ Democrats’ new ‘Better Deal’ comes up short for people of color House Dem on Statue of Liberty: ‘She persisted’ MORE (D-Mass.) and Bernie SandersBernie SandersDemocrats’ new ‘Better Deal’ comes up short for people of color Economy-focused Dems headlining Iowa fundraiser OPINION | Tomi Lahren: The liberal media twisted my words on ObamaCare MORE (I-Vt.).

Getting everyone behind a bill could prove a tall order, especially as some Republicans like Paul are committed to repealing ObamaCare, not repairing it.

  1. Should we back legislation to make key payments to insurers?

Insurers are desperate to know whether they’re going to continue to receive critical ObamaCare payments from the federal government.

President Trump has threatened to halt the payments, which compensate insurers for subsidizing out-of-pocket costs for certain healthcare consumers.

But Congress could take the matter out of his hands by authorizing the payments the administration has been making on a monthly basis, which total about $7 billion for fiscal 2017. 

Even if Trump doesn’t halt the cost-sharing reduction payments, a yearlong appropriation from Congress would give insurers certainty that they’ll continue to receive the funds.

Republicans are divided on what to do.

Many say the ObamaCare marketplaces need to be stabilized and are open to funding the payments. Alexander took the first concrete step forward to do so, saying that any stabilization package his committee produces should fund the payments.

But conservatives are vehemently opposed.

“I think it is a mistake to simply go forward with bailouts for big insurance companies,” Cruz said. “For whatever reason, the Democrats’ central priority seems to be providing billions of dollars in subsidies and bailouts to giant insurance companies.”  

  1. What’s to be done with CHIP?

Time is of the essence for Congress to reauthorize the Children’s Health Insurance Program (CHIP). Funding is set to expire Sept. 30. 

CHIP has historically had bipartisan support, and the Senate Finance Committee announced on Thursday it would hold a post-recess hearing on CHIP. 

Congress last reauthorized the CHIP program in 2015 as part of a broader health package. 

However, for Republicans still searching for a way to pass provisions of their failed ObamaCare repeal legislation, the authorizing legislation may be a tempting vehicle.

If CHIP funding expires, states will be forced to make difficult decisions about coverage. Millions of families would have to find other sources of insurance for their children at a time of uncertainty around the stability, availability and affordability of other types of coverage.

  1. What’s to be done with ‘bare’ counties?

Insurance commissioners have a big fear: That the ObamaCare health marketplaces will open for business, but people in some areas won’t have any plans to choose from.

This scenario has never happened before, but as of Friday, 17 counties have zero insurers committed to their exchange, according to Kaiser Family Foundation.

The deadline to participate is looming. Insurers sign contracts with the federal government at the end of September, saying they’ll offer plans on the ObamaCare exchanges.

If the Senate Health Committee is able to meet its goal — hammering out a bipartisan short-term stabilization bill by mid-September — then that could help prevent more insurers from fleeing the marketplaces. 

And behind the scenes, insurance commissioners have been offering insurers previously unheard of flexibilities to keep or entice them into the marketplaces.

Congress is aware of the situation and has proposed several other solutions.

One bill from Tennessee’s Republican senators, Bob CorkerBob CorkerTrump admin not opposed to new war authorization Overnight Defense: Officials discuss war authorization with lawmakers | Trump lashes out after signing Russia sanctions bill | Trump reportedly wants top Afghan commander fired Trump administration not seeking additional authorization to use force on ISIS MORE and Alexander, would let people use their ObamaCare subsidies to purchase plans off the exchange — that is, if they live in a “bare county” without any ObamaCare plans to buy.

A counter bill from Sen. Claire McCaskillClaire McCaskillMissouri attorney general forms committee to weigh Senate run 33 states accepted DHS aid to secure elections OPINION | There’s no ‘bipartisan’ solution to the ObamaCare debacle MORE (D-Mo.) would allow those in bare counties to buy coverage on Washington, D.C.’s exchange, where Congress members and their staff purchase insurance.

Peter Sullivan contributed to this report.

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