Senate Republicans continue to hammer away at a comprehensive package to replace the Affordable Care Act, but some of their colleagues are already looking beyond that bill, publicly suggesting other ways to at least score some points on an Obamacare replacement.
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Senate Majority Leader Mitch McConnell, R-Ky., said last week that he was looking to bringing a proposal to the Senate floor “in the near future,” likely before the July 4 congressional recess. But just because Senate Republicans come up with a bill doesn’t mean they have the 50 votes needed to pass it (with Vice President Mike Pence as the tie-breaker).
Sen. Mike Lee, R-Utah, who has been part of a group of senators working on the draft legislation, said Sunday on ABC News’ “This Week” that he was unsure he could vote for the bill based on what he has seen of it.
“It's not yet clear what it is going to look like, at the end of the day. I have some grave concerns about what we're doing so far,” Lee said.
While some senators like Lee are signaling they aren’t a “yes” yet, others are suggesting other, more piecemeal measures in order to rack up smaller wins on health care. Still other senators are floating different legislation entirely.
Here’s a look at some of the alternatives being presented:
Johnson: ‘Plan B’
Sen. Ron Johnson, R-Wis., told reporters last week that he thinks Senate leaders should shift to a “Plan B” before the end of the month. “You really need to fish or cut bait here on something short term to stabilize the markets,” he said.
While Johnson’s office has not expanded on what he meant, it’s possible he is referring to the $7 billion in cost-sharing payments that insurance companies receive to keep low-income consumers on their rolls. Even under current law, the fate of these payments is in dispute: House Republicans filed a lawsuit in 2014 against them, saying the payments were illegal because Congress didn’t appropriate the money, but the Trump administration said in April it was willing to continue the payments.
Enshrining the payments in standalone legislation would at least grant insurers some certainty that the payments won’t disappear, according to health care experts.
Graham: Collapse and replace
Sen. Lindsey Graham, R-S.C., has long said he believes Republicans should simply let the Affordable Care Act collapse on itself, then, assuming it does, force Democrats to be part of the coalition to rebuild the system.
Appearing on CBS over the weekend, he outlined one of the pitches he would make to Democrats, getting them on board with a high-risk pool that insulates healthier people from the higher costs associated with sicker, older people. Democrats oppose that idea because they say it would lead to much higher premiums for such sick people.
“My advice is if we can't replace Obamacare by ourselves, to go to the Democrats and say this: Ten percent of the sick people in this country drive 90 percent of the cost for all of us. Let's take those 10 percent of really sick people, put them in a federal managed care system so they'll get better outcomes, and save the private sector market if we can't do this by ourselves. That's a good place to start.”
Cassidy/Collins: A different bill altogether
While they have both participated in the Senate GOP health care talks, moderate GOP Sens. Susan Collins of Maine and Bill Cassidy of Louisiana have also never given up on a bill they wrote together. Their Patient Freedom Act would essentially wipe the slate clean, eliminating the defining elements of the ACA, including the individual mandate and the essential health benefits requirement.
But it would then allow states to decide whether to reimpose the Obamacare regulations or come up with their own system, with varying levels of government contributions based on what sort of programs they come up with.
Even as the Senate was gearing up to craft its own bill, Collins was pushing for Senate leadership to consider her and Cassidy’s bill. The two senators also met in May with a group of Democrats and Republicans to determine whether there was a bipartisan path forward on health care, for which the answer appears, at least at present, to be no.
“I urge my colleagues to support the comprehensive ACA replacement plan Senator Cassidy and I introduced that will allow more Americans to obtain health insurance, preserve significant consumer protections and help moderate the cost of health care,” Collins said in a statement.