Republican leaders don’t need Sen. Susan Collins’s vote to pass their tax-reform bill this week, but the likelihood that they’ll need her help on future agenda items gives them extra incentive to keep a legislative pledge to her to stabilize the Obamacare system.
Congressional Republicans are getting a preview of the tightrope they will have to walk next year. Collins’s vote on the Senate tax-reform bill became more important after cancer-stricken Sen. John McCain went home to Arizona. Neither senator’s vote is entirely necessary for success, as the party needs only 50 votes to pass the bill.
Collins announced Monday night that she would support the tax-reform bill after repeating her concerns about including the repeal of the Affordable Care Act’s individual mandate.
“Repealing the individual mandate without other health care reforms will almost certainly lead to further increases in the cost of health insurance, premiums that are already too expensive under the ACA,” she said on the Senate floor. “For these reasons, I’ve made it a priority to secure the passage of two bipartisan bills that will help make health insurance more affordable. Shouldn’t that be a goal that all of us can embrace?”
To get Collins’s vote for the tax bill the first time around, Senate Majority Leader Mitch McConnell pledged support for passing two Obamacare-stabilization measures before the end of the year. They would restore cost-sharing-reduction payments for two years and provide funding for reinsurance, which Collins hopes would offset premium increases from repealing the individual mandate.
But fulfilling McConnell’s pledge could be a heavy lift. Republicans aim to pass their tax-reform bill early in the week—before any potential consideration of the Obamacare measures—and then Congress has to fund the government before a Friday shutdown deadline.
House Republicans have been loath to funnel money into the Obamacare system. They released a spending bill last week without including those measures, and there are already other points of contention without them.
Collins expects the two measures to be attached to the continuing resolution in the Senate, and McConnell called on Republicans Monday afternoon to pass these bills to stabilize the health care system. But House Speaker Paul Ryan has so far not agreed to move the measures this week.
Experts say estranging Collins now, even if GOP leaders get a win on the tax bill, could make achieving their goals harder in the future. This is because incoming Democratic Sen. Doug Jones managed to pull a win in the deep red state of Alabama, lowering the Republican majority to 51-49. Republicans would be setting themselves up for less wiggle room next year if they alienate the senator from Maine, who has been a swing vote on major issues.
“Given Collins’s committee assignments, she has the potential to gum up the works if she feels that she is slighted,” said Molly Reynolds, a fellow in governance studies at the Brookings Institution.
Reynolds noted that Collins is the chair of the Transportation and Housing and Urban Development Appropriations Subcommittee.
And Collins can exert her leverage over both administrative and congressional priorities. “One of them is action on any other additional nominations,” Reynolds said.
If leadership is unable to fulfill the commitment to the senator after she casts her vote for the final tax bill, it could be embarrassing for Collins, who is already facing criticism for having supported the bill in the first place.
“She may feel there’s no point in reaching out for some compromise in the Senate because it won’t be honored in the House,” said Robert Blendon, professor of health policy and political analysis at Harvard University. “You want to honor your pledges as a leader for people who are unsure of where they should be.”
Most House Republicans strongly dislike Obamacare, and the stabilization bills will have to compete with other top-of-mind priorities, such as military spending and funding the Children’s Health Insurance Program, both of which promise to be contentious issues in the Senate.
Blendon said Collins may end up getting something much smaller than she is pushing for and that the two different proposals don’t necessarily have to travel together. He pointed out that the American Health Care Act, the House’s Obamacare-repeal bill, had funding for states to set up high-risk pools. Collins is pressing for a proposal that would provide $5 billion a year for high-risk pools or reinsurance programs.
But the cost-sharing-reduction payments, which go to insurers that cover the out-of-pocket expenses of low-income consumers, has been a point of contention. Ryan had opposed such a stabilization measure in the past.
On the Senate floor Monday, Collins did not say if House Republican leaders support the bills. “Both of these bills have the support of the president, the vice president, and the Senate Republican leaders,” she said.