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 GrahamDems revive impeachment talk after latest Cohen bombshell Overnight Defense: Second Trump-Kim summit planned for next month | Pelosi accuses Trump of leaking Afghanistan trip plans | Pentagon warns of climate threat to bases | Trump faces pressure to reconsider Syria exit Dem calls for Cohen to testify before Senate panel over explosive report 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 MurkowskiKaine to force Senate to hold rare Saturday session amid shutdown Senate rejects government-wide ban on abortion funding Senators look for possible way to end shutdown MORE (Alaska), Susan CollinsSusan Margaret CollinsOvernight Defense: Trump unveils new missile defense plan | Dems express alarm | Shutdown hits Day 27 | Trump cancels Pelosi foreign trip | Senators offer bill to prevent NATO withdrawal McConnell blocks bill to reopen most of government Bipartisan senators reintroduce bill to prevent Trump from withdrawing from NATO MORE (Maine) and John McCainJohn Sidney McCainOvernight Defense: Trump unveils new missile defense plan | Dems express alarm | Shutdown hits Day 27 | Trump cancels Pelosi foreign trip | Senators offer bill to prevent NATO withdrawal Bipartisan senators reintroduce bill to prevent Trump from withdrawing from NATO Mark Kelly considering Senate bid as Arizona Dems circle McSally MORE (Ariz.), are changing their minds.

However, Graham said he is working with conservative Sens. Mike LeeMichael (Mike) Shumway LeeHillicon Valley: Trump AG pick signals new scrutiny on tech giants | Wireless providers in new privacy storm | SEC brings charges in agency hack | Facebook to invest 0M in local news AG pick Barr wants closer scrutiny of Silicon Valley 'behemoths' Grassroots political participation is under attack in Utah and GOP is fighting back MORE (R-Utah) and Ted CruzRafael (Ted) Edward CruzGroup aiming to draft Beto O’Rourke unveils first 2020 video Howard Dean looking for a 'younger, newer' Democratic nominee in 2020 Congress can stop the war on science MORE (R-Texas) to try to incorporate their ideas on repealing ObamaCare regulations into his plan.

And Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellTSA agents protest government shutdown at Pittsburgh airport The case for Russia sanctions Pompeo planning to meet with Pat Roberts amid 2020 Senate speculation 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 BluntMcConnell: Senate won't override Trump veto on shutdown fight Senate immigration talks fall apart Emergency declaration option for wall tests GOP 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 AlexanderMcConnell blocks House bill to reopen government for second time Senators restart shutdown talks — and quickly hit roadblocks GOP senators propose bill to pay 'excepted' workers during shutdown 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 HatchPhRMA CEO 'hopeful' Trump officials will back down on drug pricing move Live coverage: Trump AG pick grilled on Mueller probe at confirmation hearing Trump praises RNC chairwoman after she criticizes her uncle Mitt Romney 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 PaulPressure mounts for Trump to reconsider Syria withdrawal House Republicans call for moving State of the Union to Senate chamber GOP rep: 'Rand Paul is giving the president bad advice' on Afghanistan and Syria MORE (R-Ky.) to progressive Sens. Elizabeth WarrenElizabeth Ann WarrenKamala Harris picks Baltimore as headquarters for potential 2020 campaign: report Dem voters split on importance of women atop the ticket in 2020 Elizabeth Warren heading to Puerto Rico next week MORE (D-Mass.) and Bernie SandersBernard (Bernie) SandersKamala Harris picks Baltimore as headquarters for potential 2020 campaign: report Sen. Casey says he won't run for president in 2020 Women's March plans 'Medicare for All' day of lobbying in DC 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 CorkerThe Memo: Romney moves stir worries in Trump World Senate GOP names first female members to Judiciary panel Former US special envoy to anti-ISIS coalition joins Stanford University as lecturer 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 McCaskillThe Hill’s 12:30 Report: Trump AG pick Barr grilled at hearing | Judge rules against census citizenship question | McConnell blocks second House bill to reopen government Ex-Sen. McCaskill joins NBC, MSNBC Some Senate Dems see Ocasio-Cortez as weak spokeswoman for party 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.