WASHINGTON — Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., have temporarily put aside their effort to overhaul Obamacare and joined a bipartisan group of lawmakers backing legislation that would shore up the law's insurance markets for two years.
Graham and Cassidy joined 10 other Republicans and 12 Democrats in support of a bill that would aim to stabilize insurance markets by guaranteeing for two years federal subsidy funding that reduces the cost of plans for low-income customers. Graham and Cassidy were the lead authors of Senate Republicans' third and final unsuccessful attempt to repeal and replace Obamacare this summer.
The new short-term bill was drafted by Health, Education, Labor and Pensions Chairman Lamar Alexander of Tennessee and ranking member Patty Murray of Washington.
“This is a first step, improve it, pass it sooner rather than later,” Alexander said on the Senate floor Thursday afternoon.
If all 48 Democrats support the bill in addition to the 12 Republicans, the legislation would have the 60 votes required to pass the Senate. But it wasn't immediately clear whether all Democrats would vote for it.
New York Democratic Sen. Kirsten Gillibrand told USA TODAY she hadn't made a decision yet but had concerns about the bill because "it’s so short term and it rolls back some of the protections.
"I think this fix, while bipartisan, is not as good as it really should be," she said.
But even if it didn't immediately have the votes to pass, Thursday’s list of co-sponsors gives new life to a bill that appeared dead as recently as Wednesday after the president tweeted that he didn’t like it.
But by Thursday, Trump seemed to be supportive of the legislation — at least as a short-term solution until Congress can pass the Graham-Cassidy bill to convert Obamacare into a block grant program to states.
"I like people working on plans at all times,” Trump told reporters. “I have great respect, as you know, for (Alexander and Murray) … if they can come up with a short-term solution.”
The bill would guarantee reimbursements to insurance companies for the discounts they’re required to give lower-income customers who buy plans on the Obamacare exchanges. Without the payments, which Trump stopped this month, insurers will need to raise premiums about 20% to make up the difference.
The bill would also restore some of the funding the Trump administration cut for consumer outreach to people who use the exchanges because they don’t have coverage through a job or a government program like Medicare or Medicaid.
The legislation would allow more people to buy “catastrophic” plans, which don’t cover most routine medical expenses but protect against major events with costs exceeding thousands of dollars.
And the bill would also make it easier for states to make changes to the individual insurance markets in their states, such as creating a fund to offset costs of the sickest customers, or modifying some of the insurance rules created by the Affordable Care Act.
Alexander argued those provisions are the best chance Republicans have of achieving their goal of giving states more control over health care.
“Some say that’s not enough,” he said. “But that’s more than we’ve gotten for eight years, and it’s the first step.”
"I think it sets the stage for something such as Graham-Cassidy. All the states said they would need at least two years to implement (Graham-Cassidy), so this gives you two years to implement if we’re successful next spring," Cassidy told reporters.
But it's unclear how many Republicans — particularly in the House — will go along with a short-term bill to stabilize Obamacare markets. Many share Trump's criticism that restoring the reimbursements to insurance companies amounts to a bailout.
“I don’t want the insurance companies making any more money than they have to,” Trump said Thursday.
Alexander said he agrees "100%" that the bill should not bail out insurers.
The bill as written would require states to certify that insures who raised rates to make up for the lack of payments won't get to keep the extra premiums if the reimbursements are resumed.
“Let’s face it, it’s not a real heavy lift to get Democrats to agree to fund Obamacare. The harder lift ... is trying to get Republicans to fund the CSRs," Sen. Ron Johnson, R-Wis., told USA TODAY. "To overcome the rhetoric, recognize reality that if we don’t fund the CSRs, taxpayers would be out even further money. That’s kind of new news to a lot of people."
Johnson has said he's working with House members to get a bill that can pass both chambers.
"It’s not going to do a whole lot of good to pass something in the Senate that dies in the House," he said.
“I think it’s a good product, but I think it has to be made better to get it through the House," Graham said. "Sen. Johnson’s working with some House members. I’m hoping something will come there.”
Trump was clear that any compromise solution could only be done for a year or two. He said he ultimately supported legislation that would get rid of Obamacare. The president had been supportive of the Graham-Cassidy bill previously.
Under the ACA, the federal government is supposed to reimburse insurers for the exact amount of discounts they give customers to reduce the cost of copayments and deductibles for people earning up to 250% of the federal poverty level. Nearly six in 10 people who use the exchanges qualify for the help.
But Republicans have argued in court that Congress never included the funding in an annual spending bill, so the Health and Human Services Department cannot pay insurance companies back.
The uncertainty of whether they would get paid for discounts they’re required to make was a main reason many insurance companies scaled back their participation in the exchanges for 2018.
That’s resulted in both fewer choices for consumers who use the exchanges and higher premiums.
“What’s conservative about creating chaos so millions can’t buy health insurance?” Alexander asked.
Contributing: Deirdre Shesgreen, Deborah Barfield Berry and Nicole Gaudiano