The Washington Post
WASHINGTON — Senate Republican leaders signaled Monday that they intend to move on from health care to other legislative priorities, even as President Donald Trump continued to pressure lawmakers to repeal and replace the Affordable Care Act.
The discord comes amid uncertainty in the insurance industry and on Capitol Hill about what will come next after last week’s dramatic collapse of the GOP’s effort to scrap the seven-year-old landmark law. Trump on Monday threatened to end subsidies to insurers and also took aim at coverage for members of Congress.
But the White House insistence appears to have done little to convince congressional GOP leaders to keep trying. One after another Monday, top GOP senators said that with no evidence of a plan that could get 50 votes, they were looking for other victories.
“We’ve had our vote and we’re moving on to tax reform,” said Sen. John Thune, S.D., one of Senate Majority Leader Mitch McConnell’s top lieutenants, speaking of the next big GOP legislative priority.
Sen. Roy Blunt, Mo., another member of the Republican Senate leadership, put it this way: “I think it’s time to move on to something else. Come back to health care when we’ve had more time to get beyond the moment we’re in — see if we can’t put some wins on the board.”
McConnell did not address health care in his remarks opening Senate business Monday afternoon. His top deputy, Sen. John Cornyn, R-Texas, brushed back comments White House budget director Mick Mulvaney made on CNN Sunday urging Republicans not to vote on anything else until voting on health care again.
“I don’t think (Mulvaney’s) got much experience in the Senate, as I recall,” said Cornyn as he made his way into the Senate chamber. “And, he’s got a big job. He ought to do that job and let us do our job.”
Mulvaney was echoing what Trump tweeted Saturday: “Unless the Republican Senators are total quitters, Repeal & Replace is not dead! Demand another vote before voting on any other bill!”
On Monday, Trump tweeted: “If Obamacare is hurting people, & it is, why shouldn’t it hurt the insurance companies & why should Congress not be paying what public pays?” He was referencing subsidies that members of Congress receive to help offset their coverage costs purchased through the District’s exchanges, as required under the Affordable Care Act.
Sen. Rand Paul, R-Ky., said Monday that based on a conversation he had with Trump, the president is considering taking executive action on health care, Reuters reported. A Paul spokesman did not immediately respond to a request for comment, and it was not clear what such an action could be. Health and Human Services Secretary Tom Price indicated over the weekend that he was considering using his regulatory authority to waive the ACA’s mandate that all Americans buy coverage or pay a tax.
Some rank-and-file Republican lawmakers have used the collapse of repeal-and-replace to offer new fixes and improvements to health care, but there was no sign their leaders were engaged. On Monday, Price met with fellow physician Sen. Bill Cassidy, R-La., who has proposed restructuring how federal money is distributed under the ACA. Separately, a bipartisan group of 43 House members released details of their own plan.
“We had a productive meeting. All involved want a path forward,” said Cassidy in a statement after his White House meeting, also attended by several governors. In addition to turning over federal funds to the states, Cassidy and Sens. Lindsey Graham, R-S.C., and Dean Heller, R-Nev., have proposed repealing key mandates and a tax under the law.
But there are no signs that plan will be put to a vote any time soon. It has not been scored by the nonpartisan Congressional Budget Office. It’s unclear how many Republicans would vote for it. And McConnell is working on confirming Trump’s nominees this week.
A growing number of Republican lawmakers have raised the prospect of working with Democrats on health care. The collection of centrist House Republicans and Democrats unveiled a proposal Monday calling for revisions they said would help stabilize the individual insurance market.
Rep. Tom Reed, R-N.Y., a co-chair of the centrist Republican and Democratic “Problem Solvers Caucus,” which released the plan, said he and his colleagues have been working on a draft for about three weeks, as they saw “the writing on the wall” that the Senate bill was likely to fail.
House Speaker Paul Ryan, R-Wis., did not champion the plan. AshLee Strong, his press secretary, said in an email: “While the speaker appreciates members coming together to promote ideas, he remains focused on repealing and replacing Obamacare.”
Strong did not respond to a follow-up question about how that ought to happen. The House passed a sweeping rewrite of the ACA this year, with only Republicans voting for it.
The Senate tried to pass its own version, but was unable to reach an accord, even on a more modest bill that was meant to keep the talks alive in both chambers. That bill was rejected Friday when Sen. John McCain, R-Ariz., joined two other Republicans to sink the legislation in a tension-filled vote that happened while most of the country was asleep.
In their outline, Reed and his colleagues said federal cost-sharing subsidies should be placed under congressional oversight and that mandatory funding should be assured. Now such disbursements are up to the Trump administration, which has been paying them monthly but has threatened to withhold them.
Top Democrats and Republicans warned against that.
“Right now, as insurers prepare to lock in their rates and plans for 2018, the Trump administration is dangling a massive sword of Damocles over the heads of millions of Americans — threatening to end payments the administration is supposed to make that would lower deductibles and out-of-pocket costs for so many Americans,” said Senate Minority Leader Charles Schumer, D-N.Y., on the Senate floor.
Thune said he was “hopeful” the administration would keep making the payments.
After Friday’s vote, some Democrats have felt more empowered to talk about changes to the ACA. The centrist House lawmakers want to repeal the 2.3 percent tax on medical device manufacturers and loosen the employer mandate under the ACA. The law says companies with 50 or more full-time employees must offer coverage. They want to raise the threshold to 500.
They also said they want to create a state stability fund to reduce premiums and spur more innovation at the state level.
Getting health care legislation backed only by Republicans to Trump’s desk by the end of August is all but impossible, even if they suddenly put aside their disagreements. The House is in recess until September. The Senate is scheduled to be in session the first two weeks of August.
The prospects of a bipartisan deal were just as doubtful, amid fierce partisanship that has gripped the Capitol in the Trump era, which has shown no signs of abating. Even those pushing for one were tempering expectations.
“We’re not stupid,” Reed said. “Those partisan swords — they’re going to be out there.”
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