Newly back from summer recess, Senators are taking two divergent paths on healthcare after the Republicans’ spectacular failure to repeal and replace the Affordable Care Act (ACA).  For Americans who rely on the ACA for health insurance, one path is encouraging; the other, fraught with peril. 

On the encouraging side, the Republican and Democratic leaders of the House Education, Labor, and Pensions (HELP) committee are working on a bi-partisan plan to stabilize the ACA insurance markets, recognizing that the healthcare of millions of Americans hangs in the balance.  In fact, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) are up against a hard deadline.  Insurers need to know the level of federal support for the ACA marketplaces before they set premiums for 2018 at the end of September.

The legislation they devise will likely beef up cost-sharing payments to insurers who waive certain out-of-pocket costs for lower income patients, as well as re-insurance payments to help insurers cover high-risk populations.  While President Trump and hardline conservatives in Congress have indicated they would be content to let the Affordable Care Act languish, Senator Alexander wisely recognizes that the public will hold Republicans accountable if Americans lose healthcare.  In other words, the GOP will own the ACA, whether they like it or not. 

Unlike the Senate and House leadership during the repeal and replace debacle, the HELP committee has been holding hearings (imagine that!) to get input from outside of Congress on possible fixes to the ACA.  Last week, a group of Republican and Democratic governors of widely different ideologies sang from the same hymnal:  the ACA marketplaces must be stabilized.

Senators Alexander and Murray must finish their hearings, mark-up the bill, pass it out of committee, and hope that it reaches the Senate floor.  If Senate leadership feels the bill has bipartisan support, it may come to a vote.  Whether all of that can happen by the end of September is anyone’s guess.

On the discouraging side, Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) just won’t let go of the repeal and replace agenda.  Undaunted by the GOP’s failure to get rid of the Affordable Care Act, Senators Cassidy and Graham are working on legislation to try, try again.  The Cassidy-Graham amendment is just as bad as - if not worse than - the failed Senate repeal bill last summer, and retains many of the most objectionable parts of the House-passed legislation.  Among other things, Cassidy-Graham:

*Ends the ACA’s Medicaid expansion  

*Cuts hundreds of billions of dollars in Medicaid spending

*Imposes per capita caps on Medicaid payments to the states

*Ends ACA subsidies and replaces them with inadequate block grants

*Leaves older and poorer Americans with no guarantee of affordable or adequate coverage

Were Senators Cassidy and Graham not paying attention when Americans at town halls across the nation expressed outrage at the GOP repeal and replace plans, including drastic cuts to Medicaid and more than 20 million people losing health coverage?  Did they not take seriously the Congressional Budget Office reporting on the negative impacts of repeal and replace on everyday Americans?  Apparently not. 

Fortunately for seniors – and all Americans who need healthcare – Senators Cassidy and Graham are running out of time.  Under Senate rules, their amendment cannot pass with a simple majority vote after the fiscal year ends on September 30th.  If they wanted to keep pushing for passage after that, they’d need 60 votes under regular order – a threshold they are not likely to meet.

Of course, it is premature for supporters of the ACA to declare victory.  We have seen seemingly dead repeal and replace bills suddenly spring back to life.  The legislative rollercoaster of last Spring and Summer are fresh in our memories.  Advocates and everyday Americans must keep the pressure on their elected representatives to work in a bipartisan fashion (like Sens. Alexander and Murray) to strengthen the Affordable Care Act– and reject repeal and replace once and for all.