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 GrahamDHS chief takes heat over Trump furor Overnight Defense: GOP chair blames Dems for defense budget holdup | FDA, Pentagon to speed approval of battlefield drugs | Mattis calls North Korea situation 'sobering' Bipartisan group to introduce DACA bill in House 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 MurkowskiSessions torched by lawmakers for marijuana move Calif. Republican attacks Sessions over marijuana policy Trump's executive order on minerals will boost national defense MORE (Alaska), Susan CollinsSusan Margaret CollinsDemocrats search for 51st net neutrality vote Overnight Tech: States sue FCC over net neutrality repeal | Senate Dems reach 50 votes on measure to override repeal | Dems press Apple on phone slowdowns, kids' health | New Android malware found Overnight Regulation: Dems claim 50 votes in Senate to block net neutrality repeal | Consumer bureau takes first step to revising payday lending rule | Trump wants to loosen rules on bank loans | Pentagon, FDA to speed up military drug approvals MORE (Maine) and John McCainJohn Sidney McCainMcCain rips Trump for attacks on press NSA spying program overcomes key Senate hurdle Meghan McCain says her father regrets opposition to MLK Day MORE (Ariz.), are changing their minds.

However, Graham said he is working with conservative Sens. Mike LeeMichael (Mike) Shumway LeeNSA spying program overcomes key Senate hurdle With religious liberty memo, Trump made America free to be faithful again This week: Time running out for Congress to avoid shutdown MORE (R-Utah) and Ted CruzRafael (Ted) Edward CruzWith religious liberty memo, Trump made America free to be faithful again Interstate compacts aren't the right way to fix occupational licensing laws Texas Dem: ‘I don’t know what to believe’ about what Trump wants for wall MORE (R-Texas) to try to incorporate their ideas on repealing ObamaCare regulations into his plan.

And Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellSessions: 'We should be like Canada' in how we take in immigrants NSA spying program overcomes key Senate hurdle Overnight Finance: Lawmakers see shutdown odds rising | Trump calls for looser rules for bank loans | Consumer bureau moves to revise payday lending rule | Trump warns China on trade deficit 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 BluntGOP senators eager for Romney to join them Senate GOP wary of ending Russia probes, despite pressure GOP on precipice of major end-of-year tax victory 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 AlexanderWeek ahead: Lawmakers near deal on children's health funding Ryan suggests room for bipartisanship on ObamaCare Time to end fiscal year foolishness 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 HatchKoch groups: Don't renew expired tax breaks in government funding bill Hatch tweets link to 'invisible' glasses after getting spotted removing pair that wasn't there DHS giving ‘active defense’ cyber tools to private sector, secretary says 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 PaulNSA spying program overcomes key Senate hurdle Fix what we’ve got and make Medicare right this year Despite amnesty, DACA bill favors American wage-earners MORE (R-Ky.) to progressive Sens. Elizabeth WarrenElizabeth Ann WarrenWarren: Trump is a 'racist bully' Poll: Oprah would outperform Warren, Harris against Trump in California Democrats continue to dismiss positive impacts of tax reform MORE (D-Mass.) and Bernie SandersBernard (Bernie) SandersMellman: On Political Authenticity (Part 2) Former Sanders campaign manager: Don't expect email list to be shared with DNC Adult film star: Trump and Stormy Daniels invited me to 'hang out' 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 CorkerSenate campaign fundraising reports roll in Congress should take the lead on reworking a successful Iran deal North Korea tensions ease ahead of Winter Olympics 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 McCaskillNSA spying program overcomes key Senate hurdle Senate campaign fundraising reports roll in Dems search for winning playbook 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.