(Bloomberg) — Senate Republicans are weighing a two-step process to change the Affordable Care Act that would postpone a repeal until 2020, as they seek to draft a more modest version than a House plan that nonpartisan analysts said would undermine some insurance markets.
Republicans — in the early stages of private talks on the Senate plan — say they may first take action to stabilize premium costs in the Affordable Care Act insurance-purchasing exchanges in 2018 and 2019. Major insurers have said they will leave the individual market in vast regions of states including North Dakota, Iowa and Missouri.
(Related: Health Bill May Shut Out One-Sixth of Sick: CBO)
A Senate plan is likely to continue subsidies that help low-income Americans with co-pays and deductibles, said third-ranking Republican John Thune of South Dakota. White House budget director Mick Mulvaney said Thursday the administration hasn’t committed to paying subsidies due in June — which would create additional uncertainty for insurers as they set rates for next year.
“There clearly has to be a short-term solution that works with the transition until some of our long-term policy changes can take effect,” Thune told reporters. “There’s got to be certainty in the marketplace.”
The private Senate GOP negotiations include a 13-member leadership-controlled working group as well as almost daily closed-door discussions among all Senate Republicans. In addition, Republican Sen. Susan Collins of Maine has convened bipartisan talks with about a dozen senators.
Republicans in the Senate are stepping up their efforts to build consensus after the nonpartisan Congressional Budget Office said Wednesday that H.R. 1628, the American Health Care Act bill that the House narrowly passed May 4 would result in 23 million more people without insurance and, in some states, plans that are too costly for older or sicker people.
Democrats in both chambers are united against efforts to replace the 2010 Affordable Care Act and said yesterday the CBO assessment provides added ammunition for the Senate fight. Senate Minority Leader Chuck Schumer said the report should be the “final nail in the coffin” in the Republican drive to repeal the Affordable Care Act.
“The report makes clear: Trumpcare would be a cancer on the American health care system, causing costs to skyrocket, making coverage unaffordable for those with pre-existing conditions and many seniors, and kicking millions off their health insurance,” said Schumer of New York.
A Quinnipiac University national poll released Thursday said Americans voters disapprove of the House measure by 57% to 20%. The May 17-23 poll of 1,404 voters had a margin of error of plus or minus 3 percentage points.
Senate Republican leaders say they expect to try to pass a bill with only GOP votes. The party controls the Senate 52-48, and the parliamentarian will determine which parts of a bill could advance under streamlined procedures that can pass with 50 votes plus Vice President Mike Pence’s tie-breaker.
Whether the GOP can attract 50 votes remains to be seen. Senators have indicated the talks have spent little time on perhaps the toughest issue: How to pay for a plan that would cover more people and offer lower premiums than the House bill. That would require retaining some of about $800 billion in Affordable Care Act taxes the House measure repeals, or finding other cost savings in the federal budget.
“I think we ought to try to look for savings anywhere we can find them,” said Senate Finance Committee Chairman Orrin Hatch, a Utah Republican. “But my experience is that we don’t find many savings.”
The subsidies for low-income insurance customers total about $7 billion a year. BlueCross BlueShield of North Carolina filed Thursday to raise its rates on average by 22.9% next year — but if the subsidies were funded, the increase would be 8.8%, according to Brian Tajlili, the insurer’s head of actuarial and pricing services.
Sen. Bill Cassidy, R-La. (Photo: Cassidy)
The health insurer has seen results from Affordable Care Exchange individual plans improve markedly after raising rates, but the uncertainty from Washington is threatening those gains. “We’re seeing the market begin to stabilize after three years of coverage,” Tajlili said in a statement.