WASHINGTON -- Senate Republican leaders on Tuesday abandoned their latest campaign to dismantle the Patient Protection and Affordable Care Act, conceding their plan lacked key support.
The decision marked the latest rejection on the issue for President Donald Trump and Senate Majority Leader Mitch McConnell, R-Ky. In July, the Republican-controlled Senate rejected three similar GOP measures, a failure that infuriated conservatives and prompted Trump to repeatedly tweet criticism of McConnell and other Republican senators for falling short.
McConnell and other Republicans characterized the decision as a short-term setback. They needed to vote on the measure this week because procedural protections against a Democratic filibuster expire Sunday, though they could revisit the issue in future months.
"We haven't given up on changing the American health care system," McConnell told reporters after holding a luncheon where members of his caucus decided against holding a futile roll call. "We aren't going to be able to do it this week."
The abandoned bill would have transformed much of the Affordable Care Act's spending into $1.2 trillion worth of grants through 2026 that states could spend on health programs with few constraints. It would also give states far more power -- without federal approval -- to loosen strings on insurers, letting them charge chronically ill people higher premiums and sell low-cost, low-coverage policies.
The nonpartisan Congressional Budget Office said "millions" of Americans would lose coverage under the bill and projected it would impose $1 trillion in Medicaid cuts through 2026.
Rejection became all but inevitable Monday after Sen. Susan Collins, R-Maine, announced that she opposed the legislation. She joined Republican Sens. John McCain of Arizona, Rand Paul of Kentucky and Texas' Ted Cruz, who had already said they opposed the measure. Cruz aides said he was seeking changes that would let him vote yes.
Sen. Lisa Murkowski, R-Alaska, did not reveal a definitive position but said that while changes in the law are needed, "substance matters." Her state has extremely high health care costs, in part because of its many remote communities.
Because of their narrow majority and unified Democratic opposition, Republicans could lose just two GOP votes and still push the legislation through the Senate. GOP leaders revised the measure several times, adding money late Sunday for Alaska, Arizona, Maine, Kentucky and Texas in a pitch for the Republican holdouts.
Senate leaders said Tuesday that they would turn their attention to their next major legislative undertaking. "Where we go from here is tax reform," McConnell said.
The collapse of the health care bill, designed by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., again left the party short of fulfilling a signature promise, which some Republicans worried could inspire a backlash among their base heading into the 2018 midterm elections.
And the failure of that alternative to the Affordable Care Act, as well as the GOP's reluctance to fix weaknesses in the existing law, left states, insurers and millions of consumers who rely on its coverage with substantial uncertainty. Enrollment for 2018 health plans begins in barely a month.
Republicans already were bracing for the political fallout. Some GOP senators have drawn primary challengers who are running as more conservative alternatives. Tuesday's developments compounded existing concerns about the threat the far right could present next year.
"They're going to be frustrated, and I don't blame them," said Sen. John Thune of South Dakota. "I hope they'll have a little bit of patience."
COST SHARING'S FATE?
The most pressing, unresolved aspect of the 2010 health care law is the future of subsidies known as cost-sharing reductions, which provide discounts to roughly 7 million lower-income customers for health plans' deductibles and other out-of-pocket costs. The payments are expected to cost the federal government $10 billion next year.
Trump has repeatedly threatened to stop the payments to insurers that offset those discounts, and both the Cassidy-Graham bill and recent bipartisan Senate negotiations would have guaranteed those payments for another year or two.
Today is the deadline for insurers to sign government contracts so they can sell health plans on the Affordable Care Act marketplaces for 2018. Many companies are increasing premium rates by double digits, but they have suggested they would curb such increases if the Trump administration agreed to provide the cost-sharing subsidies for all of next year.
Raising rates is "a best-worst solution absent a federal decision," said Peter Lee, executive director of Covered California, the state-run marketplace there.
The administration is currently only covering the cost-sharing payments on a month-to-month basis. A White House official confirmed Tuesday that it had made them for September but said officials had not decided what to do going forward.
A decision to end the subsidies would make the marketplaces particularly precarious because insurers could legally withdraw their participation, regardless of the calendar.
Julie Mix McPeak, Tennessee's insurance commissioner and the incoming president of the National Association of Insurance Commissioners, said her colleagues around the country had been "expecting some movement from Congress" on the subsidies by the end of this month.
"Nothing having moved forward makes me very nervous," McPeak said. Until today's contract deadline passes for insurers planning to sell marketplace policies in 2018, "I feel like I don't have a strong confidence we know what our markets look like. ... I'm afraid we are still looking at any environment where insurers are trying to decide whether to participate."
Kristine Grow, spokesman for America's Health Insurance Plans, said many members of her trade group "are waiting until the very last moment to make these decisions."
If Congress comes up with an agreement before the start of Affordable Care Act enrollment on Nov. 1 to continue the payments next year, insurers and health commissioners alike hope federal officials will let insurers revise their rates. In many places, they could be lowered.
Some GOP lawmakers expect consumers could experience major problems in the months ahead -- and predict those would backfire on Democrats and build momentum for the law's eventual repeal.
"I personally think it's time for the American people to see what the Democrats have done to them on health care," said Senate Finance Committee Chairman Orrin Hatch, R-Utah. "They're going to find they can't pay for it, they're going to find that it doesn't work. ... Now that will make it tough on everybody. Maybe that's what it takes to wise people up."
Trump has suggested on several occasions that, in the absence of a replacement bill, Republicans should let the current system fail as a way to force Democrats to negotiate.
Earlier this month, Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, R-Tenn., and his Democratic counterpart, Sen. Patty Murray, Wash., had been working on an agreement that would guarantee the subsidies for at least a year. The deal would have provided states with more flexibility in how they carry out the law's insurance rules.
Alexander said in a statement Tuesday that he would consult with Murray and other colleagues "to see if senators can find consensus on a limited bipartisan plan that could be enacted into law to help lower premiums and make insurance available" in the individual market for 2018 and 2019.
But it is unclear how much appetite there is for a stabilization bill among Republicans in the Senate, let alone in the House. Aides to House leaders said they do not see a bill providing billions in Affordable Care Act subsidies as viable in the lower chamber, a point House Speaker Paul Ryan, R-Wis., conveyed to GOP senators.
Democrats on Tuesday reiterated their interest in striking a deal. "Let's pick back up right where we left off, and let's do it right now," Murray said.
"The clock is ticking, Democrats are at the table, and I hope Republican leaders will now allow us to get back to work on lowering costs for patients and families and stabilizing the markets," the senator said. "We don't have a minute to spare."
Speaking to reporters Tuesday, Trump said he was "disappointed in certain so-called Republicans" who would not back the Cassidy-Graham bill.
The president had declined to speculate on whether he wanted lawmakers to vote on the measure given the likelihood of failure.
"It's going along, and at some point, there will be a repeal and replace," Trump said.
Information for this article was contributed by Juliet Eilperin, Sean Sullivan, Amy Goldstein, Kelsey Snell, David Weigel and Mike DeBonis of The Washington Post and by Erica Werner, Alan Fram, Ricardo Alonso-Zaldivar, Ken Thomas and Marcy Gordon of The Associated Press.
A Section on 09/27/2017