Another disappointment...

Trump would have to broker Obamacare truce

He could face another disappointment without a focused lobbying effort on Capitol Hill.

By JENNIFER HABERKORN and ADAM CANCRYN

A bipartisan deal in Congress offers a glimmer of stability for the Obamacare insurance markets. But for it to become law, each party will need to declare a victory — and President Donald Trump will have to agree to prop up a law he just spent months trying to repeal.

For Democrats, the deal negotiated by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) would restore key subsidies that Trump cut off just days ago. For Republicans, it would offer states flexibility to approve health insurance plans that would have the lower premiums they’ve promised voters.

The framework, which got more immediate support from Democrats than Republicans, will need the lobbying muscle of the White House to win over skeptical Republicans in Congress.

The president’s initial supportive statements in the Rose Garden and in phone calls to Alexander “are helpful because we need his support,” Alexander told reporters. “His recognizing that, in his words, he doesn’t want people to be hurt over the next two years while we’re still debating the long-term consequences of health care, that’s very helpful.”

Trump on Tuesday — despite having abruptly axed the Obamacare cost-sharing subsidies on Oct. 12 and repeatedly declared Obamacare "dead" — praised the idea of Congress restoring the payments as “a very good solution.” The president called it a “short-term solution so that we don't have this very dangerous little period — including dangerous periods for insurance companies, by the way.”

But late on Tuesday in an appearance at the Heritage Foundation, Trump further muddied his position. “While I commend the bipartisan work done by Sens. Alexander and Murray — and I do commend it — I continue to believe Congress must find a solution to the Obamacare mess instead of providing bailouts to insurance companies," he said.

But getting the deal through would require a sustained, focused lobbying effort on Capitol Hill, where Republicans are facing a biting political calculus. They’re still stinging from spending all of this year in a draining but fruitless effort to repeal and replace Obamacare — the law that congressional Republicans have been trying to uproot for seven years. Now, they would have to decide whether the state flexibilityconcessions Alexander got are enough.

“Clearly it'd be helpful for President Trump to be on board” to win over conservatives, said a GOP senator. “I would think President Trump would find this appealing not as a solution — no one's selling it as a solution — but as a short-term measure to avoid over the next year and a half having continued instability in the marketplace."

That senator, like many fellow Republicans, was reluctant to stake out a position, having only heard the broad-strokes outline from Alexander in a closed-door lunch meeting.

House Republicans, who earlier this year approved an Obamacare repeal bill only to be left hung out to dry by the Senate, are even more skeptical.

“The GOP should focus on repealing & replacing Obamacare, not trying to save it. This bailout is unacceptable,” conservative Republican Study Committee Chairman Mark Walker said. "Obamacare is in a 'death spiral.' Anything propping it up is only saving what Republicans promised to dismantle.”

Conservative groups aren’t giving the deal any air cover to restore the subsidies, which cover out-of-pocket medical bills for low-income people. The insurers legally have to make those payments, whether the government keeps the subsidies flowing or not. The uncertainty over the subsidies is why some insurers fled the
Obamacare markets — and those that stayed raised premiums to cover the costs.

The Heritage Foundation said funding the cost-sharing program would “prop up the subsidized Obamacare exchange market but would do absolutely nothing to stabilize” the broader market.

“What is instead needed to stabilize the unsubsidized market is the removal of Obamacare’s cost increasing insurance mandates and misguided regulations,” said Ed Haislmaier, a health policy expert at the Heritage Foundation.

"Obamacare doesn't need a lifeline," Club for Growth spokesperson Rachael Slobodien emailed POLITICO. "Its cord needs to be pulled."

Freedom Partners also pushed back hard, urging conservatives in Congress to insist that any compromise include an elimination of Obamacare's individual and employer mandates.

But Sen. Mike Rounds (R-S.D.), who has worked with Alexander to whip up support, expressed confidence that Trump could convince skeptical Republicans to fall in line. "The fact that the president has indicated a real interest in seeing a bipartisan fix like this move forward for a short-term fix is critical," Rounds said. "If the White House said, 'Look, we're not interested in it,' then I don't think we'd be able to go anyplace with it."

Democrats on Tuesday were eager to hear more. They have a much lower political risk to signing on: They want to see the health care law succeed and would love for Republicans to have more political ownership of the law and the 2018 premium rates.

As part of the deal to reinstate the subsidies, Democrats agreed that states could allow a new catastrophic health plan — a so-called copper plan along with the more generous gold, silver and bronze — that would cost less but still include the basic package of Obamacare benefits.

The clock is ticking. Alexander and Murray are trying to enact a bill that could have an effect on 2018 premiums, the vast majority of which have already been set by insurance companies and approved by states. The lawmakers say they’re trying to add into the bill assurances that savings would have to be passed onto consumers but have not yet released details.

Alexander said Tuesday that he’d like to have a “significant” number of Republican and Democratic co-sponsors by the end of this week. From there, he says, he wants to hand the legislation off to Majority Leader Mitch McConnell and Minority Leader Chuck Schumer to figure out how to enact it.

Alexander knows he has his work cut out for him. Throughout weeks of negotiations, he has repeatedly said that he would only push forward a plan that he believes could get “significant” bipartisan support, including concessions designed to appeal to his party's more ardent Obamacare opponents. A summary of the proposal circulated Tuesday appeared aimed at accomplishing just that, emphasizing that the deal would cut premiums, shift power to the states and avoid adding a penny to the deficit.

It included a warning: If Republicans don't act now, the resulting chaos will provide a "four-lane highway" for Democrats to speed toward single-payer health care.

If Alexander can get enough Republican support, a stand-alone bill seems unlikely, in part because some Republicans are fearful of tying up the Senate floor with a return to the contentious Obamacare debate. The more likely option is to attach it to another piece of legislation. Some Democrats are eyeing a year-end spending bill as an option.

McConnell on Tuesday didn’t commit to the timing of a possible vote.

“We haven't had a chance to think about the way forward yet,” he told reporters.

Murray said Tuesday afternoon that it'll now be solely up to Senate Republican leaders to figure out what comes next. She and Alexander came up with the product. As for the process of getting it passed, she said, "ask Mitch."