McConnell willing to hold Senate vote on bipartisan health deal if Trump endorses, but what are the odds of passage?

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The News:

Senator Mitch McConnell of Kentucky, the majority leader, said on Sunday (October 22, 2017) that he would be willing to bring a bipartisan proposal to stabilize health insurance markets up for debate if President Trump signaled his support, according to the New York Times.

“If there’s a need for some kind of interim step here to stabilize the market, we need a bill the president will actually sign,” Mr. McConnell said on CNN’s State of the Union.  “And I’m not certain yet what the president is looking for here, but I’ll be happy to bring a bill to the floor if I know President Trump would sign it.”

Mr. McConnell’s comments shifted attention to Mr. Trump, who has sent mixed signals about a proposal unveiled last week by Senators Lamar Alexander, Republican of Tennessee, and Patty Murray, Democrat of Washington. The president has seemingly left enough of an opening for the plan to proceed.

The proposal would extend federal payments to insurance companies through 2019 to reimburse discounts that the companies are required to provide to millions of low-income people who have coverage under the Affordable Care Act. Mr. Trump, who says that repealing President Barack Obama’s signature health law remains a top priority, had announced this month that he was cutting off those subsidies.

Lawmakers from both parties have spoken out in support of the proposal, and Mr. Trump had initially encouraged the talks between Mr. Alexander and Ms. Murray, the top two senators on the health committee. But on Wednesday (October 25, 2017), he tweeted that while he was supportive of the effort, “I can never support bailing out” insurance companies, which he said had made a fortune under the ACA.

Sarah Huckabee Sanders, the White House press secretary, then suggested that Mr. Trump could be won over if changes were made to the legislation.

“He wants to lower premiums,” Ms. Sanders said. “He wants to provide greater flexibility. He wants to drive competition. He likes the idea of block grants to states.”

Democrats have strenuously opposed block grants and have shunned another proposal renewed by the White House in recent days: the repeal of the requirement for most Americans to have health insurance.

Senator Chuck Schumer of New York, the Democratic leader, appeared reluctant to restart negotiations. Asked on NBC’s Meet the Press on Sunday if Democrats would return to the negotiating table, Mr. Schumer said:

“We have an agreement. We want to stick by it.”

Steve’s Take:

Am I just kidding myself about the slim odds of the Alexander-Murray bill getting through both chambers of Congress and then surviving what seems certain to be a veto in the Oval Office? Is that rational? Of course, as I’m writing this, it’s only Tuesday (October 24, 2017).

While the bipartisan deal announced last week offers a flicker of steadiness for the Obamacare insurance markets, each party still needs to declare a victory. Politico’s Jennifer Haberkorn and Adam Cancryn make a great point saying,

“President Donald Trump will have to agree to prop up a law he just spent months trying to repeal.”

The inference is, forget that. Yet the bill needs Trump’s weighty lobbying influence. With many skeptical Republicans in Congress, the White House will need to win over GOP members who have spent years voting to repeal Obamacare, not mend it.

Sen. Alexander told reporters seemingly supportive comments from Trump, “are helpful because we need his support. His recognizing that, in his words, he doesn’t want people to be hurt over the next two years while we’re still debating the long-term consequences of health care. That’s very helpful.”

The White House has spent recent days fluctuating between backing and criticizing the bipartisan effort, and last Tuesday, Trump further blurred his position, praising Alexander and Murray’s work but adding he doesn’t want a bailout to insurance companies.

But key swing votes are cautiously positive.

“This bill may not be perfect,” GOP Sen. Susan Collins said on Meet the Press Daily. “I would have liked to have seen a specific authorization and some seed money for reinsurance pools, which would further help to lower premiums. But this is a good package, and I hope it will be passed very quickly so it can have an impact on rates this year.”

Analysts see signs of a shift in GOP thinking.

“We’ve seen more Republicans concede publicly that they will be seen as responsible for the state of healthcare markets in 2018 and in 2020,” Jacob Leibenluft of the Center for Budget and Policy Priorities told PULSE, pointing to a series of statements by congressional Republicans. “Alexander-Murray appears to be an acknowledgment that if Republicans break the ACA, they own it–and that they share an interest in stabilizing the market.”

According to Shannon Firth for MedPage Today, several policy scholars said the Senate will probably pass the bill but whether it can win enough votes in the more conservative House is less certain. Contradictory predictions abound, per usual.

Bottom Line:

I’m leaning toward the conclusion of one lobbyist and attorney who said what Trump thinks of the bill is irrelevant.

“I think if they pass something in both houses, he’ll sign it and then he’ll take the credit for it,” said Julius Hobson Jr., JD, senior policy advisor for Polsinelli, an 800-lawyer firm based in Kansas City, and an adjunct professor at the Graduate School of Political Management at George Washington University.

Sixty votes are needed for a bill to pass the Senate through regular order.

“With 12 Republicans and all of the Democrats, you’re there,” Hobson said.

Schumer has in fact said he believes every Democrat will support the bill, according to The Washington Examiner; in fact the Senate democrat is calling for an immediate vote.

Steve's Take: If Alexander-Murray passes #Congress, @realDonaldTrump will very likely sign it Click To Tweet

Sally Pipes, president and CEO of the Pacific Research Institute, a conservative San Francisco-based think-tank, said she’s “not a fan” of the bill and agrees with the administration’s decision to scrap the CSR payments.

“If Congress can pass a bill to make them legal, then that’s all fine,” Pipes said. “[But] it makes me nervous that the longer they continue them, the harder it will be to get rid of them.”

The bill also restores funding for ACA navigators and marketing, which Pipes said is not money well spent.

“I think the Obama administration spent a fortune on ads using movie stars and sports heroes,” said Pipes with unimpressive results.

“The question is, is the House going to keep holding out for a complete repeal and replace as opposed to a stabilization,” said Marianne Udow-Phillips, PhD, Executive Director of the Center for Healthcare Research & Transformation at the University of Michigan.

She said Graham, Cassidy and other conservatives may push the bill to the right, by stripping “guardrails” in the waivers that allow states to redesign their exchanges. That could make it more palatable to House Republicans, but could lose Democrats in the process.

As a stand-alone bill, Joe Antos, PhD, of the conservative American Enterprise Institute, said the bill has “zero chance” of passing both houses, but predicted the CSR payments will be restored for 2018 by packaging the authorization into other legislation.

Continuation into 2019 may be more difficult, he said. Antos said he couldn’t see a path for the bulk of the navigator funding to be renewed, though some might be. He said a better strategy would be to include funding for insurance agents who are legally authorized to sign people up.

Time is running out: the 2018 enrollment period opens Nov. 1. It won’t be easy for insurers to refile rates and the system of rebates the senators have proposed is still hazy.

“I think the critical mass comes when open enrollment starts and the consumers are looking on line and they’re going ‘Holy you know what, I can’t afford that’” Hobson said.

“It’s hard to unscramble eggs,” said Tim Jost, JD, an emeritus professor at the Washington and Lee University School of Law and member of the Institute of Medicine, who said all of this could have been avoided if a bill had been passed weeks ago. He continued:

“The Congress’s inability to recognize and deal with this issue [coupled with] the president’s absolute capriciousness has resulted in is a big mess, which is going to be hard to straighten out. If [the current bill] doesn’t pass, then we’ve just got a bunch of people in this country that will not be able to afford health insurance next year and…a lot of them look like Trump voters.”

You are reading this, aren’t you Mr. President?

Update:

Reuters on Wednesday (October 25, 2017) reported that House Speaker Paul Ryan said Republican lawmakers will not take up the Alexander-Murray bipartisan plan to stabilize Obamacare this year.

“I think that is something we should do next year,” Ryan said in an interview when asked about prospects of the House passing a bipartisan bill.

Ryan said he favored a more conservative short-term Obamacare fix offered by leading Republicans in the House and Senate. It includes provisions to suspend requirements for individuals and employers to obtain health coverage under Obamacare.

Democrats are likely to balk over concerns that the measure could undermine the viability of Obamacare’s subsidized insurance market for individuals.

Steve’s Take:

Keep in mind, as I’m writing this, it’s only Wednesday (October 25, 2017). I’m fairly certain someone else in Washington, most likely Mr. Trump, will have something to say about Speaker Ryan’s remarks before the end of the week. Stay tuned.