Getting legislation passed in an effort to keep Obamacare premiums down—by providing more money to insurers—may be contingent on whether the Senate will need Sen. Susan Collins’s vote to get the final tax package passed.
In order to secure Collins’s vote for the Senate tax-reform bill last week, Senate Majority Leader Mitch McConnell told the senator he supported passage of bills that would restore cost-sharing-reduction payments and funding for reinsurance programs. Collins views both of these policies as an important way to offset premium increases resulting from the Senate tax bill’s repeal of the individual mandate.
But the Senate tax legislation passed through the chamber 51-49, meaning Collins’s vote technically wasn’t needed. The Senate in the end has to keep at least 50 votes and Vice President Mike Pence can break the tie.
“It’s difficult at this point for Collins to enforce the promise that was made to her in exchange for her support,” said Molly Reynolds, a fellow in governance studies at the Brookings Institution. “If she were to threaten against the conference bill, they have the votes to pass it.”
The vote math matters because those guarantees made to Collins are not going over well with House Republicans, who view the cost-sharing subsidies as “bailouts,” and Speaker Paul Ryan’s office distanced itself from the negotiations Monday.
With both chambers set to negotiate the several differences between their two tax-reform bills, House Ways and Means Committee Chairman Kevin Brady said he is whipping the conference to see how the House—which did not include individual-mandate repeal in its tax bill—feels about retaining that provision from the Senate proposal.
“I suspect there will be strong support,” Brady said.
The strings attached to this provision in the Collins deal, however, are not as popular. Rep. Tom Cole, chair of the Appropriations subcommittee that oversees the Health and Human Services Department, suggested that it would be hard for him to vote for a continuing resolution to fund the government with cost-sharing-reduction payments included.
“I would have a very hard time voting for it,” he said. “But I think our leadership knows that. They’re not going to consent to something like that.”
The House may not feel compelled to provide such funds if passage of the tax-reform bill will not be threatened, suggested Robert Blendon, professor of health policy and political analysis at Harvard University. He added he could not foresee the White House—which has called cost-sharing-reduction payments “bailouts” in the past—holding up the tax reform and funding the government over these bills.
The current continuing resolution to prevent the government from shutting down at the end of this week does not include the bills promised to Collins, but this has not concerned the senator.
“It’s my understanding that this is a very short-term CR, and I suspect that it will be in the next one,” Collins said. She said she would prefer the bills to be passed before the tax-reform package is finished, but added that this is not a deal-breaker as long as they are passed by the end of the year.
Reynolds said it will likely be critical to get the promised legislation attached to a larger bill, such as an omnibus, on which Republicans may already anticipate losing a sizable chunk of the caucus in the House. “If they’re going to get something done on that, it’s going to come [in] a broader piece of legislation,” she said.
And whether or not House leadership ends up putting a spending bill with the Obamacare fixes on the floor, Ryan appears to have distanced himself from this part of the negotiation. According to The Hill, Ryan’s office told a meeting of congressional leadership offices that he did not take part in the deal.
“If he thinks there is a possibility he’s going to have to put it on the floor of the House as a condition to keep the government open, he doesn’t have fingerprints on it,” Reynolds said.
Repealing the individual mandate would allow Republicans to say they took a first step to undo the Affordable Care Act, and it would play better if the cost-sharing-reduction payments aren’t on the table, Blendon said.
Ryan on Tuesday reiterated that he thought repealing and replacing Obamacare was still a good idea for Republicans.
“Well, of course I think that’s the best way we can go, but we’re going to have continued discussions with our members here in the House and across the aisle about the best way forward,” he told reporters. “We think health care is deteriorating; we think premiums are going up through the roof, insurers are pulling out, and that’s not a status quo that we can live with.”