Sunday, July 30, 2017

Thwarted again, Republicans in Washington are divided about whether to keep trying to pass a health-insurance bill

Pence, McConnell and Trump in happier days (Getty Images)
By Al Cross
Kentucky Health News

After his last-ditch attempt to pass a health-insurance bill failed early Friday morning, Senate Majority Leader Mitch McConnell said, "It's time to move on," and scheduled other business.

President Donald Trump, hungry for a legislative victory, did not agree.

"Unless the Republican Senators are total quitters, Repeal & Replace is not dead! Demand another vote before voting on any other bill!" Trump said Saturday on Twitter.

Trump aides confirmed Sunday that the tweets are presidential policy. "The president will not accept those who say, quote, 'It's time to move on'," Trump adviser Kellyanne Conway said on "Fox News Sunday."

Some House Republicans also said work on health insurance should continue, but they are scheduled to recess at week's end. "The Senate is scheduled to work another two weeks," The Associated Press notes. "McConnell has said the unfinished business includes addressing a backlog of executive and judicial nominations, ahead of a busy agenda in September that involves passing a defense spending bill and raising the debt limit."

In several tweets, Trump called on McConnell and other Republican senators to eliminate the filibuster, which effectively requires 60 votes to pass significant legislation.

“The very outdated filibuster rule must go. Budget reconciliation is killing R's in Senate. Mitch M, go to 51 Votes NOW and WIN. IT'S TIME!” Trump wrote. “Republicans in the Senate will NEVER win if they don't go to a 51 vote majority NOW. They look like fools and are just wasting time.”

McConnell has repeatedly said that he will not support eliminating the filibuster, and "a McConnell aide said it's not going to happen," reports John Bennett of CQ-Roll Call.

In another tweet, Trump threatened to cut off subsidies of insurance for people whose incomes are less than 250 percent of the federal poverty level, or a family of four with annual income of about $85,000: "If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!" he wrote Saturday.

In an aside during a speech Friday, Trump repeated his threat to "let Obamacare implode." Insurance companies say ending the subsidies would further destabilize Obamacare's individual insurance market. The Kaiser Family Foundation has estimated that it would raise the cost of a typical plan by 15 percent in states that expanded Medicaid (including Kentucky) and 21 percent in other states.

Sen. Susan Collins of Maine, one of three Republicans to vote against McConnell's bill and a former state insurance commissioner, said Trump's threats have already "contributed to the instability in the insurance market" and "I seriously hope that in the meantime the president doesn't do anything to hasten that collapse." She said the payments are "not an insurance company bailout but help people who are very low income avoid their out-of-pocket costs . . . It would really be detrimental to the most vulnerable citizens if those payments were cut off."

Office of Management and Budget Director Mick Mulvaney told Jake Tapper on CNN's "State of the Union" the president's tweets reflect official policy, and "I think what you see there is simply the president reflecting the mood of the people. . . . You can't promise folks you're going to do something for seven years and then not do it. . . . They need to stay, they need work, and they need to pass something."

Mulvaney said Trump's congressional bailout reference was to an Office of Personnel Management decision two years ago that "allowed a special exemption to the rules on employer contributions to those plans." The rule insulates members and staff from premium increases on the government insurance exchange by allowing them to get employer contributions from the government to pay for plans on the small-business exchange for the District of Columbia.

As Trump called for action, some Republicans in the House and Senate met to discuss how that could be done. Rep. James Comer of Western and Southern Kentucky's 1st District "said he expects the next steps for health-care reform to include bipartisan efforts," Sarah Loesch reports for The Gleaner in Henderson.

McConnell said in late June that if Republicans did not agree "and change the status quo . . . markets will continue to collapse and we’ll have to sit down with Senator [Chuck] Schumer,” of New York, the Democratic leader. “Doing nothing is not an option.” McConnell has not repeated that warning, at least not publicly, and has seemed wary of a bipartisan approach.

McConnell said after his bill died Friday that he wanted to hear ideas from Democrats, but "Bailing out insurance companies without any thought of reform is not something I want to be part of."

Sen. David Perdue (R-Ga.) said that when he heard Schumer say early Friday that Obamacare needs major reforms, he started talking to Democrats about compromises, but other Republicans suggested they would oppose bipartisan talks.

“I don’t think the Democrats have any interest in doing anything productive” on health care, said Sen. Ted Cruz (R-Tex.). “Republican senators are going to go home. They’re going to hear from their constituents, and I don’t expect the response to be muted.”

Collins said "the first bill we should consider" is one to stabilize the insurance market, and called for a bipartisan approach, as did Sen. John McCain of Arizona when he returned from a brain-cancer diagnosis to cast a vote allowing debate on the issue last week. McCain cast the deciding vote against what he called McConnell's "shell bill" that the leader said was designed to take the issue to a House-Senate conference committee. The votes of McCain, Collins and Alaska's Lisa Murkowski made the tally 51-49. "Most people expected a tie," Collins said Sunday.

The cost-sharing subsidies expire Monday, July 31, and other deadlines loom.

"The drawn-out health care debate on Capitol Hill has left lawmakers and administration officials with very little time to reassure jittery insurers that the markets created by the ACA will be stable enough for them to offer plans at a reasonable rates," Ed O'Keefe reports for The Washington Post. "Companies must set their final rates by Aug. 16 and states must submit the rates they’ve approved to federal officials by Sept. 27."

Sens. Lindsey Graham has an alternate plan and met at the White House on Friday with Sens. Bill Cassidy of Louisiana and Dean Heller of Nevada, fellow Republicans. "The bill’s supporters are telling administration officials and congressional aides that the bill will score far better than previous efforts, which CBO analyses project would cause millions more uninsured people and short-term spikes in premiums," report Burgess Everett, Josh Dawsey and Rachel Bade of Politico.

"Several senior Republican Senate aides and allies of GOP leaders cautioned against any feelings of momentum coming from the White House on Saturday," especially after Trump's tweets about the filibuster. "McConnell has resisted such a suggestion publicly and has been pushing back against Trump privately, according to people familiar with their interactions. One person close to McConnell said Trump has asked McConnell personally to change the rules but said no."

The Politico reporters add, "Senate rules don’t appear to be the problem. From the 'skinny repeal' bill to a McConnell designed replacement bill to a so-called “clean” repeal bill, all GOP efforts failed to get 50 votes in the Senate," at which point Vice President Mike Pence could break the tie in Republicans' favor.

The Post's Mike DeBonis and Amber Phillips write that congressional Republicans “now live in the worst of both worlds -- with nothing to show for seven years of campaign promises, even though dozens of vulnerable lawmakers cast votes that could leave them exposed to attacks from Democrats. . . . Republicans have continually failed to coalesce around an alternative — vividly demonstrated by the dramatic failure of the 'skinny repeal' on the Senate floor early Friday morning. They appear trapped in the fallacy of sunk costs: Having invested so much political capital in the ACA’s repeal, they cannot possibly abandon it.”

Former McConnell chief of staff Josh Holmes, a Republican strategist who often reflects his former boss's views, told the Post that Republicans should “Quarantine it. You can let it destroy your entire agenda and your entire party as a result of inaction by continuing to dwell on something that, frankly, they’ve proven unable to do.”

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