On Thursday, it became clear that House Republicans were not budging in their opposition to a measure negotiated between the Republican chairman and the Democratic ranking member of the Senate’s health committee aimed at keeping health care premiums lower in 2018 and beyond. Conservative hardliners in the House are frustrated with the lack of movement on a complete repeal and replace of Obamacare, and are poised to kill the bipartisan compromise that now has the backing of 12 Republicans and 12 Democrats in the Senate.
“I’m a little less worried about what Democrats think and much more concerned about what Republicans promised,” Rep. Mark Walker (R-N.C.), the chairman of the conservative Republican Study Committee, told The Daily Beast in a phone interview on Thursday.
Like many of his colleagues in the House, Walker has derided the agreement negotiated by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) that extends Obamacare subsidies known as cost-sharing reduction (CSR) payments for two years and gives state governments more flexibility to set insurance regulations under what is known as a 1332 waiver. Conservatives in the lower chamber, whose support was integral for the House-passed Obamacare repeal-and-replace bill, have been frustrated with the Senate’s failure to follow suit.
“The country’s off-course big time. The Democrats are just promising free candy to everybody. And that’s not a mature response,” Rep. Dave Brat (R-VA), a member of the hardline House Freedom Caucus, told The Daily Beast in a phone interview. “[Alexander-Murray], as it is? No way. It’s not even in the ballpark.”
Walker, like many of his colleagues, views the Alexander-Murray agreement as propping up a failed law. But one of their chief criticisms of the Affordable Care Act was that it would lead to higher premiums and insurers pulling out of the marketplace altogether—both of which would occur if Congress does nothing to restore the CSR payments that Trump disbanded last week, according to the nonpartisan Congressional Budget Office.
Both Walker and Brat dismissed those concerns entirely, contending that the only way to give Americans true health care relief would be to scrap Obamacare entirely. Walker said an agreement that passes muster in the House must also include a repeal of Obamacare’s individual and employer mandates, in addition to the taxes under the law.
But a package that includes those provisions is a non-starter for Democrats in any bipartisan deal because that would effectively dismantle the crux of Obamacare. Alexander, who is leading the effort in the Senate, said lawmakers should realize that a short-term market stabilization package is necessary even if Republicans had the votes to repeal and replace Obamacare as soon as this week—which they do not.
“We’ve got a gap between today and even if Republicans are successful in repealing and replacing Obamacare, that’s two or three years from now,” Alexander said, referring to the gradual implementation period of an ACA replacement. “We don’t want chaos in the next two or three years. We don’t [want] millions of Americans who can’t buy insurance.”
The Tennessee senator suggested that the House could write its own version of the legislation and President Trump could “help put the two together.” But both seem entirely unlikely. House Speaker Paul Ryan issued a statement through a spokesman on Wednesday that Walker—who said he spoke with Ryan on Wednesday night—interpreted as a declaration of opposition.
“The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare,” the spokesman said.
Later Thursday, Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-LA)—who are co-sponsoring Alexander-Murray—said in a statement that the agreement “will not pass unless concerns of the House are addressed.” The senators said they are working with House members to “include more flexibility provisions like the ones found in our legislation, Graham-Cassidy-Heller-Johnson,” the Senate’s most recent scuttled effort to repeal Obamacare.
“Without a stabilization package, the market will collapse and advance premium tax credits will spike,” the senators warned. “This would increase the costs to the American taxpayer.”
Alexander followed suit with a defiant statement imploring Republican holdouts to support his bill, writing in part: “What’s conservative about creating chaos so millions can’t buy insurance?” Earlier in the day, Alexander said he had not spoken with Ryan about the speaker’s concerns with the bill.
“I hope he’s working on tax reform,” Alexander said. “I know that he is, and I’m glad that he is. Almost every Republican member of the House has already voted for it. It was in the repeal-and-replace bill.”
Alexander was referring to the extension of CSR payments that was included in the House-passed bill as a bridge until the full implementation of the Obamacare replacement. But House members have indicated clearly that they’re not willing to support a stabilization bill that does not contain a guarantee of a full repeal and replace in the future. Alexander-Murray does not offer that guarantee.
“Even though I may not like it, even though I may not be comfortable with it, there may be a situation where we have to considering extending the CSRs at least in a temporary setting if we can get guarantees that this allows us a vehicle to protect the people who are struggling under Obamacare,” Walker said.
Alexander also issued a warning to his Republican colleagues skeptical of the compromise he brokered: support our effort, or be prepared for a single-payer health care system.
“I think it will become increasingly unanimous in the Republican caucus that… if we do nothing, we’ll create chaos, and chaos will lead to a birthday present for Bernie Sanders, which is a single-payer solution which none of us want,” Alexander said.
With the Senate and House holding divergent views of the Alexander-Murray compromise, the president isn’t solidly in one camp, either. Last week, he cut off the CSR payments—only to suggest a few days later that he would sign a bill that includes a two-year extension of them. The White House’s position has been that Congress should appropriate the payments, rather than the executive; but at the same time, Trump has called them “bailouts” for insurance companies. Before that, he indicated he was supportive of the Alexander-Murray effort. On Thursday, Trump reiterated his opposition to any provision that helps insurance companies.
“I don’t want the insurance companies making any more money because they made a fortune off Obamacare,” Trump said. “Anything that they’re working on is a very short term, meaning one year to two years max.”
A Democratic aide told The Daily Beast that lawmakers suspect Trump wants to sign a stabilization measure into law but is facing resistance from his staff, raising “questions about who’s really running the show over there on these issues.” To that end, White House Legislative Affairs Director Marc Short told The Daily Beast on Tuesday that the White House believes it already has enough state flexibility under the Obamacare 1332 waivers, and that the administration wouldn’t simply rubber-stamp an extension of the CSR payments without getting something significant in return—for example, as Walker suggested, scrapping the individual and employer mandates, which are non-starters for Democrats.
Paired with Trump’s tweet slamming the CSR payments as a “bailout” for insurance companies, the administration’s concerns over the deal as it stands today could be enough to tank it altogether. But Alexander is so invested in the effort that he’s willing to change the legislation to address the White House’s concerns.
“We have strong language in the Alexander-Murray agreement that consumers get the money and not the insurance companies,” Alexander told reporters. “And if the administration has stronger language, we’ll put it in.”
Still, Alexander will have a harder time selling the plan to his caucus than Murray will with hers. Democratic support is expected to be nearly unanimous; so the measure would almost certainly pass the 60-vote threshold even if only the 12 Republican co-sponsors joined Democrats in voting for it. But despite the whip count, Alexander and his allies have acknowledged the reality that they need to craft the bill to the president’s liking.
“It really doesn’t go any place until we find language that’s acceptable to him,” Sen. Mike Rounds (R-S.D.) told The Daily Beast.