Even if the Senate GOP measure to repeal and replace Obamacare can’t be resurrected, future must-pass health legislation will offer Republicans smaller stabs at the law if they are unable to bridge the divide within their party.
The current Republican effort to repeal portions of the Affordable Care Act was still in limbo Wednesday night. After Senate Majority Leader Mitch McConnell scrapped a repeal-and-replace measure that had been in the works for weeks, President Trump pushed for the effort to be revived at a lunch with lawmakers Wednesday afternoon.
“We have no choice; we have to repeal and replace Obamacare,” Trump said at the lunch. “We can repeal it, but the best is repeal and replace, and let’s get going.”
But it’s unclear if leadership will be able to get the votes together on the bill that aims to loosen insurance regulations, repeal Medicaid expansion, and slow the spending growth rate for the entire program. And McConnell’s Plan B—a straight repeal bill that initially passed Congress in 2015—appeared to be dead on arrival Tuesday. McConnell left the door cracked open Wednesday to still pursue either option.
As lawmakers have been preoccupied with Obamacare repeal, deadlines for other bills are looming in September, and could possibly offer Republicans a vehicle to get smaller changes passed.
One such measure is the extension of funding for the Children’s Health Insurance Program, also known as CHIP or SCHIP, past Sept. 30. The program has broad bipartisan support, but is ripe to carry smaller changes such as adding work requirements to Medicaid, experts say.
“I think CHIP has been held hostage with no action as they’ve been debating repeal and replace. … It’s clearly a vehicle that they’ve left out there,” said Diane Rowland, executive vice president at the Kaiser Family Foundation. Rowland noted that even the contours of the CHIP legislation by itself are unknown.
While some lawmakers sounded skeptical about using the CHIP funding bill as an option for health reform, Senate Finance Committee Chairman Orrin Hatch has considered that option.
“Yeah, that would be another route because that’s a bill that everybody wants. That’s my bill,” Hatch told National Journal. He did not provide details on what changes he would be interested in including.
Even if Republican lawmakers do not attempt to include health reform measures in the CHIP bill, the length of time for which the program is extended can be telling. Ilisa Halpern Paul, president of the District Policy Group, said a shorter-term reauthorization could provide a hint that Republicans may still try to reform the Medicaid program.
“If they do a very long reauthorization, it could suggest they are letting go of Medicaid reform for now,” Paul said.
Sen. Mike Rounds also floated the possibility of using the CHIP bill—but as a means to continue tweaking the law after a Senate repeal bill was passed.
“If we were to come to a solution on this particular part, then SCHIP could be used to fine-tune items that you can’t do by reconciliation because you have broad support for the renewal or continuation of the SCHIP plan. So you gain some more supporters, Republicans and Democrats alike,” Rounds said. “But if you lose on the reforms that we’re proposing in this particular plan, then I don’t think there’s going to be a huge amount of support for simply adding benefits or modifying things in SCHIP, but it’s possible.”
Another potential vehicle for health care changes could be legislation to renew the Food and Drug Administration’s authority to collect user fees from the drug and medical-device industries.
Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, said there’s been a strong bipartisan commitment not to attach non-germane amendments to the user-fee legislation—but that could change.
“Who knows whether the broader politics, post-whatever happens on the repeal vote, could change things?” Park said.
Even if Obamacare repeal were to die next week on the floor, Park said changes included in the measure, such as the proposed Medicaid cuts, could return in the Republican tax-reform efforts. And that may be GOP lawmakers’ best bet if they cannot bridge the divide over a large repeal measure.
Sen. Susan Collins, one of the Republicans who have helped derail the Senate repeal efforts, sees opportunities to fix the Affordable Care Act through the committee process, beginning with the Health, Education, Labor, and Pensions panel chaired by Sen. Lamar Alexander.
“I’ve encouraged Senator Alexander to hold hearings in the HELP Committee, he’s agreed to do so, and I hope those hearings will begin shortly,” Collins said. “We can then look at issues such as what can we do to moderate the increases in premiums, how can we bring stability to the market, how can you give people more choices in insurance.”
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