President Donald Trump on Wednesday reveled in Congressâ€™ passage of a massive $1.5 trillion tax reform bill, claiming that, once he signed it into law, it would propel economic growth.
WASHINGTON â€” Congressional Republicans will open their 2018 legislative agenda wrangling over a politically dicey and very familiar issue: Obamacare.
Moderates want to bolster the Affordable Care Act, especially in the face of possible new hikes in premiums for insurance consumers.
Conservatives want to take another shot at killing the 2010 health care law, even though the GOPâ€™s attempts to do that consumed much of 2017 and ended in an embarrassing failure.
“There are Republicans who are ready to make peace and go forward, and those that will never,â€ said Rodney Whitlock, a former Senate GOP health policy staffer and now a lobbyist.Â
This time around, Republicans will face more pressure to act, especially in the Senate. Thatâ€™s because Senate Majority Leader Mitch McConnell, R-Ky., promised a key GOP moderate he would push for passage of two bills designed to stabilize Obamacare and keep premiums down in the individual insurance market.
In exchange,Â Sen. Susan Collins, R-Maine, agreed to vote in favor of the GOP tax bill which passed last month and has now been signed into law by President Trump. The tax law includes a repeal of the mandate for individuals to obtain healthÂ insurance, which was established underÂ the ACA to prompt young, healthy people to purchase insurance and thereby make insurance cheaper for sicker, older Americans.
Without that population in the mix, average premiums will increase by 10 percent for most years over the next decade, according to an analysis by the Congressional Budget Office.The tax law nixes the mandate starting in 2019.
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In addition to the premium increases, the CBO has estimated that 13 million Americans will drop off the insurance rolls by 2027 without the mandate in place. Some will choose not to buy insurance, while others will no longer be able to afford it.
â€œWe must have other health care reforms in place in order to prevent further increases in the cost of health insurance,â€ said Annie Clark, a spokeswoman for Collins. â€œSenator Collins believes that averting these price spikes, particularly for low-income families, should be a goal members of both parties can embrace.â€
Collins is pushing two bipartisan bills:
One proposal, written by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., aims to shore up Obamacare insurance markets. It would guarantee two years of reimbursements to insurance companies for the reduced co-payments and deductibles they are required to provide to low-income consumers. Trump has halted those subsidy payments, which are worth around $7 billion this year. The Alexander-Murray bill would also expand the authority for states to experiment with alternative insurance standardsÂ that deviate from the Obamacare minimum requirements.
The second measure, written by Collins and Sen. Bill Nelson, D-Fla., would set aside at least $2 billion in a â€œreinsurance fundâ€ to help states protect health insurers from catastrophic losses sustained from coverage of high-risk patients under the Affordable Care Act.Â
McConnell originally promised CollinsÂ that he would push the two bills through Congress last month. But that plan faced stiff opposition in the House, where Speaker Paul Ryan, R-Wis., said he was not bound by McConnellâ€™s agreement.
Conservatives in the House are staunchly opposed to any legislation that would prop up Obamacare. They say the Alexander-Murray proposal is a bailout for insurance giants.
Other Republicans say they should turn back to repealing Obamacare all together and replacing it with a GOP alternative. McConnell has suggested he would only revisit a repeal-and-replace bill if he was sure it would pass the Senate â€” a steep challenge given that Republicans will only control 51 votes chamber starting Wednesday, when a newly elected Democrat, Doug Jones of Alabama, is sworn in.
â€œI’d love to be able to make more substantial changes to Obamacare than we have,â€ McConnell said at a year-end Dec. 22 news conference. But, he added, 51-49 is â€œa pretty tight majority.â€
Whether McConnell can convinceÂ Ryan to go along with the two Collins-backed bills is unclear. Supporters say the most promising strategy is to attach the proposals to a spending agreement that lawmakers will take up in the next few weeks
Current funding for the government will run out on Jan. 19th, so Congress must pass a new spending bill before then to avert a shutdown.
Whitlock said he believes Ryan will be forced to swallow a Senate-passed bill to stabilize the insurance market, especially if Trump backs such a deal and itâ€™s attached to a spending bill to keep the government open.
â€œJan. 19th is the new deadline,â€ he said.
Alexander predicted that House Republicans would warm up to the health care fixes amid pressure from voters.Â
“All of us have constituents that are getting hammered by health insurance premiums,” the Tennessee Republican told reporters last week. “… IfÂ we can bring them down 20 percent, we should do it. And I think we will do it.”
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Contributing: Michael Collins and Ledyard King