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Bipartisan Health Care Compromise Falls Apart, Obamacare Battle Continues

Sen. Lindsey Graham, R-S.C., left, and Rep. Ryan Costello, R-Pa., conduct a news conference in the Capitol on legislation to lower health insurance premiums for citizens who pay out of pocket on March 21, 2018. (Tom Williams/CQ Roll Call)
Sen. Lindsey Graham, R-S.C., left, and Rep. Ryan Costello, R-Pa., conduct a news conference in the Capitol on legislation to lower health insurance premiums for citizens who pay out of pocket on March 21, 2018. (Tom Williams/CQ Roll Call)

The politics of health care reared its ugly head yet again.

A grand, bipartisan bargain to stabilize the U.S. individual insurance market fell apart this week. And members on both sides of the aisle turned to what they know best: blaming the other party.

Republicans say Democrats threw a last-minute wrench in the negotiations by insisting that aspects of the package be exempt from commonly used appropriations language that prevents federal funding from being used for abortions.

“We have always said that this bill would go in the omnibus bill, to which the Hyde language has applied every year since 1976,” Sen. Lamar Alexander of Tennessee, chairman of the Senate Health, Education, Labor and Pensions Committee and the Republican lead negotiator on the legislation, said. “That’s always been the case. Nothing has changed.”

Snow Day in Washington: Sledders, Cancelled Events and Waiting for the Omnibus

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“As a pro-choice Republican, I am puzzled by the Democratic response to the language that is in the bill,” added Sen. Susan Collins, R-Maine, who has been involved in the negotiations to craft a proposal.

Democrats counter that Republican leadership purposely tanked the package by adding in provisions they knew would poison the effort.

“It’s really clear to me today that Paul Ryan, Mitch McConnell had other ideas and they have blocked this. If they truly want to get this done, they’ll take away the parts that we’ve been clear since the beginning we can’t support,” Sen. Patty Murray of Washington, the top Democrat on the Senate health panel, said.

And so the world turns. Only this time, the looming health care battle could be uglier than it has in years.

“I’ve never been more disappointed in my Democratic colleagues of sitting on the sidelines and watching hard-working Americans pay a price in premiums cause they’re trying to win a political argument,” Sen. Lindsey Graham, R-S.C., said. “This is phony, I hope you lose votes, I hope you lose seats. You’re not worthy of governing this place.”

The fresh partisan bickering ensures that Congress will almost certainly not advance any sort of measure that could reduce premiums before insurers file their rates for 2019. It also all but confirms that the 2010 health law will again be a central focus of the upcoming midterm elections.

Republicans still want to overhaul the law after failing to do so last year and the White House appears unlikely to back down on any of their proposed changes to the law that critics say significantly undermine it. Democrats will point to the robust enrollment in the individual market as a sign the law is succeeding, and will likely seek to build upon it should they retake the House next year.  

But as lawmakers continue their over years-long battle over Obamacare, it is Americans who will feel the brunt of the seemingly endless battle over the future of the U.S. health insurance system.

A February report by the left-leaning Urban Institute projected that premiums would increase 18 percent on average in most states because of the elimination of the penalty for not having insurance coverage and the Trump administration proposal to expand how long consumers can maintain short-term policies.

While the markets have shown signs of turmoil and premiums have subsequently risen, the GOP attempts to overhaul the law added significant uncertainty. That, coupled with President Donald Trump’s decision to end the so-called cost sharing subsidies, has also contributed to insurers raising coverage costs.

Looming Changes

While Congress is unlikely to act on health care, the administration continues to move full-throttle to overhaul the law.

The Department of Health and Human Services has in recent months proposed regulations to expand both who can can band together to purchase health insurance through association health plans and how long consumers can maintain short-term insurance policies. Democrats say these policies would allow the sale of “junk insurance,” and have called for a stabilization package to reverse some of the proposed regulations

The administration last year cut off funding that would reimburse insurers for providing cost-sharing reduction payments, which help low-income consumers afford certain out-of-pocket costs. Advocates for the health law say that the market has mostly adjusted to that change. Some lawmakers seized on that and have insisted that funding should not be restored because it could make premiums more expensive for some poorer consumers.

But as the Trump administration continues to act unilaterally, the congressional debate over the future of the law could get more dicey.

A growing coalition of Democratic lawmakers support a move towards a single-payer health system, a proposal vehemently opposed by many Republicans. Should Democrats win back the House, it is possible members will push leadership to advance such a measure, despite its abysmal prospects under a GOP-controlled Senate and White House.     

The Never-Ending Health Care War

The divide between the Republicans and Democratic positions on health care policy is widening and the battle over the future of the U.S. insurance system will only get more fraught as a result.  

For example, some Republicans have said a stabilization package should include provisions to guarantee that short-term plans could be renewed from year-to-year, while Democrats pushed for a package to expand the size of the tax credits that help consumers afford health insurance.

Republicans say Democrats want to use rising insurance premiums as a political issue ahead of the midterms — which will come roughly a month after individual market rates are finalized — and suggested that’s why they walked away from negotiations.

“It makes you think that maybe they want the political argument in the fall, rather than solve the problem today,” said Rep. Greg Walden, R-Ore., the chairman of the Energy and Commerce Committee.

Some Democrats want to pursue a more holistic approach to fixing the health care system and examine in greater depth some controversial ideas, like allowing Medicare to sell insurance policies.

“The situation changes all the time,” Sen. Tim Kaine, D-Va., said. “People’s willingness to try new strategies also change.”

Conservatives, meanwhile, are celebrating a victory and saying the exclusion of a stabilization deal from the omnibus fortifies their argument to return to efforts to overhaul the law.

“Republicans should be concerned. Fairly or unfairly the public views them as owning health care right now and a large part of that was that they were unsuccessful in repealing and replacing the law they’ve been campaigning against,” said Dan Holler, a vice president at Heritage Action.

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