Senate Republicans are weighing a two-step process to replace Obamacare that would postpone a repeal until 2020, as they seek to draft a more modest version than a House plan that nonpartisan analysts said would undermine some insurance markets.
Republicans — in the early stages of private talks on the Senate plan — say they may first take action to stabilize premium costs in Obamacare’s insurance-purchasing marketplaces in 2018 and 2019. Major insurers have said they will leave the individual marketplaces in several states, including Iowa, Missouri and North Dakota.
A Senate plan is likely to continue subsidies that help low-income Americans with copays and deductibles, said third-ranking Republican John Thune of South Dakota. White House budget director Mick Mulvaney said Thursday that the administration hasn’t committed to paying subsidies due in June — which would create additional uncertainty for insurers as they set rates for next year.
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“There clearly has to be a short-term solution that works with the transition until some of our long-term policy changes can take effect,” Thune told reporters. “There’s got to be certainty in the marketplace.”
The Senate Republicans’ private negotiations include a 13-member leadership-controlled working group as well as almost daily closed-door discussions among all Senate Republicans. In addition, Sen. Susan Collins, R-Maine, has convened bipartisan talks with about a dozen senators.
Republicans in the Senate are stepping up their efforts to build consensus after the nonpartisan Congressional Budget Office said Wednesday that the House plan would result in 23 million more people without insurance and, in some states, plans that are too costly for older or sicker people.
Democrats in both chambers are united against efforts to replace the 2010 Affordable Care Act, and said Wednesday that the CBO assessment provides added ammunition for the Senate fight. Minority Leader Chuck Schumer, D-N.Y., said the report should be the “final nail in the coffin” in the GOP drive to end Obamacare.
A Quinnipiac University national poll released Thursday said American voters disapprove of the House measure by 57 percent to 20 percent.
Senate Republican leaders say they expect to try to pass a bill with only GOP votes. The party controls the Senate 52-48, and the parliamentarian will determine which parts of a bill could advance under streamlined procedures that can pass with 50 votes plus Vice President Mike Pence’s tiebreaker.
Whether the GOP can attract 50 votes remains to be seen. Senators have indicated the talks have spent little time on perhaps the toughest issue: how to pay for a plan that would cover more people and offer lower premiums than the House bill. That would require retaining some of about $800 billion in Obamacare taxes the House measure repeals, or finding other cost savings in the federal budget.
“I think we ought to try to look for savings anywhere we can find them,” said Senate Finance Committee Chairman Orrin Hatch, R-Utah. “But my experience is that we don’t find many savings.”
The subsidies for low-income insurance customers total about $7 billion a year. Blue Cross Blue Shield of North Carolina filed Thursday to raise its rates on average by 22.9 percent next year — but if the subsidies were funded, the increase would be 8.8 percent, said Brian Tajlili, the insurer’s head of actuarial and pricing services.
The health insurer has seen results from Obamacare plans improve markedly after raising rates, but the uncertainty from Washington is threatening those gains.
“We’re seeing the market begin to stabilize after three years of coverage,” Tajlili said in a statement.