Five tough decisions for the GOP on healthcare

Republicans have left Washington for the August recess with healthcare decisions hanging overhead, many of which must be addressed by the end of September.

Here are five decisions looming for the GOP.

  1. Should there be one more effort at ObamaCare repeal?

While the GOP attempt at repealing ObamaCare has stalled for now, some in the party are not giving up.

"This ain't over by a long shot … we won't rest until we end the ObamaCare nightmare once and for all,” Vice President Pence said at the Tennessee GOP 2017 Statesmen's Dinner Thursday, according to a pool report.

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Yet Republicans are running out of time to take action, as the legislative vehicle they were using to gut the healthcare law and avoid a Democratic filibuster expires at the end of September.

Sens. Lindsey GrahamLindsey Olin GrahamDurbin: I had 'nothing to do' with Curbelo snub Republicans jockey for position on immigration Overnight Health Care: House passes 20-week abortion ban | GOP gives ground over ObamaCare fix | Price exit sets off speculation over replacement MORE (R-S.C.) and Bill Cassidy (R-La.) are pushing a new plan to redirect money currently spent on providing coverage through ObamaCare and instead give it to states to spend as they choose. 

They have been meeting with White House officials, who are also pushing Congress not to give up on repeal.

“I hope that our leadership will pay attention to this effort, because the idea of leaving ObamaCare without a replacement is pretty naive,” Graham said this week.

Still, Senate GOP leadership has largely signaled they are moving on from repeal for now, with the legislative session in September likely to be dominated by work on funding the government and raising the debt ceiling. 

And there are so far no signs that any of the three GOP “no” votes who sunk repeal, Sens. Lisa MurkowskiLisa Ann MurkowskiRepublicans jockey for position on immigration GOP senator knocks Trump: 'Not a fan of governing by tweet' How the effort to replace ObamaCare failed MORE (Alaska), Susan CollinsSusan Margaret CollinsGun proposal picks up GOP support Giffords, Scalise highlight party differences on guns Agricultural trade demands investment in MAP and FMD MORE (Maine) and John McCainJohn Sidney McCainRubio asks Army to kick out West Point grad with pro-communist posts The VA's woes cannot be pinned on any singular administration Overnight Defense: Mattis offers support for Iran deal | McCain blocks nominees over Afghanistan strategy | Trump, Tillerson spilt raises new questions about N. Korea policy MORE (Ariz.), are changing their minds.

However, Graham said he is working with conservative Sens. Mike LeeMichael (Mike) Shumway LeeWhatever you think the Alabama special election means, you’re probably wrong How the effort to replace ObamaCare failed Overnight Regulation: Trump temporarily lifts Jones Act for Puerto Rico | Bill would exempt some banks from Dodd-Frank | Senators unveil driverless car bill MORE (R-Utah) and Ted CruzRafael (Ted) Edward CruzWhatever you think the Alabama special election means, you’re probably wrong This week: Congress gets ball rolling on tax reform Week ahead: Senators work toward deal to fix ObamaCare markets MORE (R-Texas) to try to incorporate their ideas on repealing ObamaCare regulations into his plan.

And Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellGun proposal picks up GOP support Children’s health-care bill faces new obstacles Dems see Trump as potential ally on gun reform MORE (R-Ky.) left the door open to bringing repeal back in some form, noting the fast-track procedure being used to avoid a filibuster had not expired. 

“There’s still an opportunity to do that,” he said.

  1. Should we work with Democrats?

Lawmakers are ramping up bipartisan talks on the next steps for healthcare legislation, some more enthusiastically than others.

Sen. Mike Rounds (R-S.D.) said that following the failure of the Senate GOP’s ObamaCare repeal vote, Democrats have been more willing to talk with Republicans about ways to fix the law.

“Both sides are moving a little bit more to the middle,” Rounds said. “The discussions I’m having have been positive with Democrats, saying, ‘Look, we are open to these changes, we will listen, we will work with you.’”

Sen. Roy BluntRoy Dean BluntThe Hill's Whip List: Republicans try again on ObamaCare repeal Another health funding cliff puts care for millions at risk Top Senate Dem: We're going forward with understanding we can work with White House on DACA MORE (R-Mo.), a member of the GOP leadership, told The Hill he still wants to repeal ObamaCare “and start over, but that doesn’t mean an effort to hold up the collapsing structure in the short term isn’t the right thing to do.”

Both the Senate’s Health and Finance committees plan to hold bipartisan hearings in September when lawmakers return from recess.

Sen. Lamar AlexanderAndrew (Lamar) Lamar AlexanderChildren’s health-care bill faces new obstacles Overnight Health Care: Schumer calls for tying ObamaCare fix to children's health insurance | Puerto Rico's water woes worsen | Dems plead for nursing home residents' right to sue Schumer calls for attaching ObamaCare fix to children's health insurance MORE (R-Tenn.) — the chairman of the Health Committee — said the goal is for the panel to craft a bipartisan, short-term proposal by mid-September, as insurers must sign contracts saying they’ll sell plans on the federal exchange by the end of that month.

Finance Committee Chairman Orrin HatchOrrin Grant HatchGOP eyes limits on investor tax break Children’s health-care bill faces new obstacles Overnight Finance: White House requests B for disaster relief | Ex-Equifax chief grilled over stock sales | House panel approves B for border wall | Tax plan puts swing-state Republicans in tough spot MORE (R-Utah) did not suggest the panel would produce legislation, but he said there was bipartisan interest in a hearing.

“We’ve also heard a lot of demands from members of the committee for a healthcare hearing. I intend to do that as well shortly after the recess,” Hatch said Thursday. 

But it’s not clear that the renewed interest in bipartisanship will yield legislation.

Alexander’s committee runs the ideological gamut from conservative Sen. Rand PaulRandal (Rand) Howard PaulHouse bill set to reignite debate on warrantless surveillance Authorizing military force is necessary, but insufficient GOP feuds with outside group over analysis of tax framework MORE (R-Ky.) to progressive Sens. Elizabeth WarrenElizabeth Ann WarrenOvernight Finance: Lawmakers grill Equifax chief over hack | Wells Fargo CEO defends bank's progress | Trump jokes Puerto Rico threw budget 'out of whack' | Mortgage tax fight tests industry clout Michelle Obama is exactly who the Democrats need to win big in 2020 Wells Fargo chief defends bank's progress in tense Senate hearing MORE (D-Mass.) and Bernie SandersBernard (Bernie) SandersChris Murphy’s profile rises with gun tragedies Clip shows Larry David and Bernie Sanders reacting after discovering they're related For now, Trump dossier creates more questions than answers MORE (I-Vt.).

Getting everyone behind a bill could prove a tall order, especially as some Republicans like Paul are committed to repealing ObamaCare, not repairing it.

  1. Should we back legislation to make key payments to insurers?

Insurers are desperate to know whether they’re going to continue to receive critical ObamaCare payments from the federal government.

President Trump has threatened to halt the payments, which compensate insurers for subsidizing out-of-pocket costs for certain healthcare consumers.

But Congress could take the matter out of his hands by authorizing the payments the administration has been making on a monthly basis, which total about $7 billion for fiscal 2017. 

Even if Trump doesn’t halt the cost-sharing reduction payments, a yearlong appropriation from Congress would give insurers certainty that they’ll continue to receive the funds.

Republicans are divided on what to do.

Many say the ObamaCare marketplaces need to be stabilized and are open to funding the payments. Alexander took the first concrete step forward to do so, saying that any stabilization package his committee produces should fund the payments.

But conservatives are vehemently opposed.

“I think it is a mistake to simply go forward with bailouts for big insurance companies,” Cruz said. “For whatever reason, the Democrats’ central priority seems to be providing billions of dollars in subsidies and bailouts to giant insurance companies.”  

  1. What's to be done with CHIP?

Time is of the essence for Congress to reauthorize the Children’s Health Insurance Program (CHIP). Funding is set to expire Sept. 30. 

CHIP has historically had bipartisan support, and the Senate Finance Committee announced on Thursday it would hold a post-recess hearing on CHIP. 

Congress last reauthorized the CHIP program in 2015 as part of a broader health package. 

However, for Republicans still searching for a way to pass provisions of their failed ObamaCare repeal legislation, the authorizing legislation may be a tempting vehicle.

If CHIP funding expires, states will be forced to make difficult decisions about coverage. Millions of families would have to find other sources of insurance for their children at a time of uncertainty around the stability, availability and affordability of other types of coverage.

  1. What's to be done with 'bare' counties?

Insurance commissioners have a big fear: That the ObamaCare health marketplaces will open for business, but people in some areas won’t have any plans to choose from.

This scenario has never happened before, but as of Friday, 17 counties have zero insurers committed to their exchange, according to Kaiser Family Foundation.

The deadline to participate is looming. Insurers sign contracts with the federal government at the end of September, saying they’ll offer plans on the ObamaCare exchanges.

If the Senate Health Committee is able to meet its goal — hammering out a bipartisan short-term stabilization bill by mid-September — then that could help prevent more insurers from fleeing the marketplaces. 

And behind the scenes, insurance commissioners have been offering insurers previously unheard of flexibilities to keep or entice them into the marketplaces.

Congress is aware of the situation and has proposed several other solutions.

One bill from Tennessee’s Republican senators, Bob CorkerRobert (Bob) Phillips CorkerDeficit hawks voice worry over direction of tax plan The Hill Interview: Budget Chair Black sticks around for now Overnight Finance: White House requests B for disaster relief | Ex-Equifax chief grilled over stock sales | House panel approves B for border wall | Tax plan puts swing-state Republicans in tough spot MORE and Alexander, would let people use their ObamaCare subsidies to purchase plans off the exchange — that is, if they live in a “bare county” without any ObamaCare plans to buy.

A counter bill from Sen. Claire McCaskillClaire Conner McCaskillKoch-backed group targets red-state Dems on tax reform Overnight Cybersecurity: Equifax security employee left after breach | Lawmakers float bill to reform warrantless surveillance | Intel leaders keeping collusion probe open Las Vegas highlights Islamist terrorism is not America's greatest domestic threat MORE (D-Mo.) would allow those in bare counties to buy coverage on Washington, D.C.’s exchange, where Congress members and their staff purchase insurance.

Peter Sullivan contributed to this report.