Tough decisions loom for Dems on ObamaCare


http://thehill.com/policy/healthcare/355754-tough-decisions-loom-for-dems-on-obamacare

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Congressional Democrats have to decide how badly they want an ObamaCare deal.

Senate Republicans are open to renewing the insurer payments that President Trump canceled last week, but, in return, they want to expand a program that allows states to waive Affordable Care Act regulations.

That asking price could be hard for Democrats to swallow.

While Democrats want to protect ObamaCare, they fear that expanding the waivers would allow states to chip away at the bedrock protections of the law, including the rules on what an insurance plan must cover.

The politics of the health-care debate are also shifting.

While ObamaCare used to be a liability for Democrats, a Kaiser Family Foundation poll in August found that 60 percent of respondents think Republicans are responsible for problems in the Affordable Care Act going forward. Only 28 percent said the responsibility rests with Democrats.

Polls like that make some Republicans nervous about an ObamaCare backlash in the 2018 elections. And Democrats, hopeful of winning back the House and potentially even the Senate next year, are eager to hang ObamaCare’s problems around the GOP’s neck.

“Republicans in the House and Senate now own the health-care system in this country from top to bottom, and their destructive actions, and the actions of the president, are going to fall on their backs,” Senate Minority Leader Charles Schumer (D-N.Y.) said on Friday.

Negotiations over an ObamaCare bill have been going on for weeks, with Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) seeking an agreement to stabilize the markets and protect people’s coverage options.

Democrats say they are pushing for a deal, and Murray said Friday she was “optimistic” that one could be reached.

Trump’s decision to cancel the payments to insurers added fresh urgency to the talks. Health-care experts warn the loss of the payments — meant to offset the cost of insuring some lower-income people — could cause insurers to flee the system before open enrollment begins Nov. 1.

Several Republicans have said they are worried their constituents will be hurt by a collapse of the marketplaces, seemingly bolstering the talks.

But it’s far from clear that any ObamaCare deal reached by the Senate can become law.

Speaker Paul Ryan (R-Wis.) said last month that an Alexander-Murray deal is “not viable” for the House GOP.

And Trump on Monday sent mixed signals about whether he’d be willing to sign a bill reviving the ObamaCare payments.

The president declared that ObamaCare is “dead” and boasted that he had ended the “gravy train” of payments to insurers, causing their stock prices to drop.

“Hundreds of millions of dollars a month handed to the insurance companies for very little reason, believe me. I want the money to go to the people. … I want the money to go to people that need proper health care, not to insurance companies, which is where it’s going as of last week. I ended that,” he said.

Yet Trump also seemed to endorse the Alexander-Murray talks, stating that the two parties are “meeting right now and right now they’re working on something very special.”

“I do believe we’ll have a short-term fix because I think the Democrats will be blamed for the mess. This is an ObamaCare mess,” he said.

Sen. Lindsey Graham (R-S.C.), who golfed with Trump over the weekend, said on CBS on Sunday that Trump had spoken with Alexander and that Trump is open to a deal to continue the cost-sharing reduction payments if there is enough flexibility for the states.

“We are willing to work with Congress  to reach a legislative solution,” a White House aide said. “We will not provide bailouts to insurance companies until we provide the American people with relief from the ObamaCare disaster.”

Schumer said  on Monday in a written statement that he welcomes Trump’s support for a deal.

“I’m hopeful that we are nearing an agreement that makes clear that we have no intention of supporting the president’s efforts at sabotage,” he said. “If he’s now supportive of an agreement that stabilizes and improves the existing system under the Affordable Care Act, we certainly welcome that change of heart.”

The negotiations have been hung up on the question of how far to go in waiving ObamaCare’s regulations.

Republicans say it is not enough to speed up the process for a state to get a waiver; instead, the scope of the waivers must be broadened.

Alexander says he has agreed to fund two years of the ObamaCare payments, known as cost-sharing reductions, which is more than his original offer of one year. He says Democrats need to give up something in return.

Democrats argue that they have already made significant concessions, including agreeing to expand low-cost “copper” health insurance plans, streamlining the waiver process by letting states choose from a “menu” of options and allowing insurers to charge higher out-of-pocket costs for some services.

Asked Monday if he wanted more flexibility for states than Democrats are willing to give, Alexander replied, “I want as much as we can get.”

“I mean, I would like to repeal and replace ObamaCare, and Sen. Murray would like to keep it intact, but that’s not how you make a compromise,” he said.

Alexander said Trump has encouraged him to make a deal, as has Schumer.

“I find that very encouraging, that both the president and Sen. Schumer encouraged me to do something,” Alexander said.

Still, he declined to put any timetable on when an agreement could be reached.

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