Congress’s ability to solve a series of year-end puzzles on health care, spending, and possibly immigration may well depend on a key question: What do Democrats want most?
Democrats are eager to see funding extensions for the Children’s Health Insurance Program and community health centers as soon as possible. They want some increases in domestic spending and eventually, they’d like a solution to the issue of immigrants who were brought to the U.S. illegally as children. They’d also like to see measures passed that might stabilize Obamacare’s marketplaces.
But with Republicans in charge, Democrats can’t have it all. And the health measures that Senate Majority Leader Mitch McConnell backed in order to get the tax bill passed out of the chamber seem to be a lower priority for the Democrats, while many House Republicans are reluctant to take them up at all.
McConnell told Sen. Susan Collins of Maine that he would support passage of two Obamacare-stabilization bills: one that would provide cost-sharing-reduction payments and another that would fund reinsurance programs. In return, Collins voted for the tax bill that included the repeal of Obamacare’s individual mandate, the requirement that everyone purchase health insurance.
The best chance for passing either piece of legislation by the end of the year is to attach them to the spending deal. But House GOP leadership has thrown a wrench into this idea after promising Republican Study Committee Chairman Mark Walker that cost-sharing payments would not be included.
And there does not appear to be much momentum behind these bills from the Democrats; they want to defeat the repeal of the individual mandate to begin with.
Sen. Ron Wyden, who named wildfire prevention and treatment as well as protecting safety-net programs as his top priorities, cast doubt on the idea that these measures would be helpful in stabilizing the health care market should the individual mandate be removed.
“When you devastate the health care system, I think Senator [Patty] Murray and Senator [Bill] Nelson would say you don’t get everybody well again by having some reinsurance or some cost-sharing, you just don’t,” said Wyden, naming the Democratic cosponsors for both measures.
Instead, Democrats have a different health care add-on for the year-end spending bill: to fund CHIP and community health centers. Funding for both expired at the end of September and the short-term continuing resolution passed last week included a patch for states about to run out of CHIP funding.
House Energy and Commerce ranking member Frank Pallone named funding for CHIP and community health centers as the two main December goals for his committee. When it came to the health-care-stabilization measures, he said he would be willing to support them, but cast doubt on whether Republicans would act on those bills. “I would obviously support that, but the most important thing is CHIP and community health centers,” he said.
Other Democrats indicated that the importance of the Obamacare-stabilization legislation depends on the final outcome for the GOP tax bill.
“The tax bill and the budget are now all conflated, because if you’re going to get rid of the individual mandate and you’re not going to do something to stabilize the markets, millions of people are going to lose their insurance and everybody else’s insurance rates are going to go up,” Rep. Diana DeGette said. She added that she would probably support a government funding bill with cost-sharing payments in it, but that she would have to see what the entire legislation looked like.
At a press conference last week, House Minority Leader Nancy Pelosi displayed a poster with year-end budget priorities that did not include health-care-market stabilization, though she did not rule out its being included. “However, what we have to do is defeat this tax scam first,” she said.
In the end, it’s the Senate that is in a tight box when it comes to the tax-reform bill because of Collins. “The Republicans in the Senate could say, ‘No, we’re not doing this,’ and dare her to vote against the tax bill,” said Molly Reynolds, a fellow in governance studies at the Brookings Institution. “They have no room to maneuver.”
Reynolds noted, though, that if there appears to be a bloc of House conservatives who are going to object to the spending bill anyway for other reasons, there would be less incentive for leadership to keep the Obamacare-stabilization bills out of the deal.
Collins, for her part, appears confident that the promises made to her will be honored by Senate leaders and the White House.
“I’ve talked to the president three times about this issue, and once again I have no reason to believe that that commitment will not be kept,” she said on Face the Nation. “After all, who wants to see health insurance premiums become more unaffordable than they already are for individuals who are buying insurance in the individual market?”