Obamacare repeal has been in a vegetative state for more than a month now. Some say that, for all practical purposes, the GOP’s quest to abolish the Affordable Care Act has been dead since late July. Others insist that Trumpcare has shown flickering signs of vitality, and still has an outside shot at recovery.
On Friday, the Senate parliamentarian ostensibly proved the former camp right: Elizabeth MacDonough informed congressional Republicans that the reconciliation instructions that empower them to repeal Obamacare with 51 Senate votes will expire at the end of September. Any attempt to repeal Barack Obama’s signature law after this month would be subject to a filibuster — and, thus, require Democratic votes. (Technically, Republicans could pass a new budget resolution with reconciliation instructions related to Obamacare repeal, but such a move would seriously complicate their tax “reform” efforts, and is therefore, highly unlikely.)
The chances of Obamacare repeal passing by September’s end are essentially nil. There are only 12 legislative days this month — and in that time, Congress needs to pass a spending bill to keep the government open, raise the debt ceiling, appropriate funds for Harvey relief, and reauthorize the Children’s Health Insurance Program. If congressional Republicans couldn’t find common cause on health care over the past eight months, there’s no way they’re going to find it in those 12, jam-packed days.
But that doesn’t necessarily mean that this Congress won’t pass any health-care legislation in the near future. Republicans may be incapable of gutting Obamacare by themselves — but they could still modestly reform the law, with Democratic help.
Or, so hopes Republican senator Lamar Alexander. He and his Democratic colleague Patty Murray will hold a series of hearings this month to explore ways of strengthening Obamacare’s exchanges. They hope to follow those hearings with a modest, bipartisan measure to improve the existing system, thereby preempting a steep rise in premiums.
The Alexander-Murray plan’s chief ambition is already known: to make it more difficult for President Trump to sabotage our health-care system. Under Obamacare, insurance companies that suffer significant losses by covering low-income enrollees receive federal subsidies that defray those costs (and, thus, prevent said companies from jacking up their premiums). But the power to distribute those payments currently lies with the Executive branch. Trump can cancel them at any time. And he has threatened to do so, repeatedly. Were the president to abruptly cancel the cost-sharing subsidies, premiums would promptly rise by 20 percent, according to the Congressional Budget Office.
Even if Trump doesn’t cancel the subsidies, but merely continues to leave their future in doubt, insurers are likely to raise premiums as a defensive measure.
Since Republicans have full control of the government, they’re likely to receive the lion’s share of the public’s blame if health insurance gets markedly more expensive next year. And so, according to The Wall Street Journal, a “number of Senate Republicans are gathering behind” Alexander’s bill, which would ensure that those subsidies get paid.
But in the House, where many Republicans are insulated from popular discontent by gerrymandering, there is less appetite for shoring up Obamacare. And this week, the Trump administration signaled that it hasn’t fully forfeited its dreams of repealing the ACA through sabotage: On Thursday, the Department of Health and Human Services slashed funding for advertisements and grants that encourage Americans to sign up for Obamacare. (The more young and healthy people who sign up for insurance under the law, the lower insurers can set premiums.)
It’s still possible that, eventually, a bipartisan bill will prevail. But in all likelihood, that legislation will come too late to prevent a spike in premiums: To offer plans on the Obamacare exchanges next year, insurers will need to sign federal contracts — and make decisions about premiums — by September 27.
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