Washington is waiting to see whether Trump will give a green light to the Alexander-Murray legislation that might help stabilize Obamacare markets and give states more flexibility under the existing law. The chairmen of House and Senate committees with partial jurisdiction over health-care policy big-footed their way into the conversation with a competing proposal that sure sounds like what Trump has been promoting. Senate Finance Committee chairman Orrin Hatch and House Ways and Means Committee chairman Kevin Brady paused from their tax-cut labors long to enough to unveil a significantly more conservative “stabilization” proposal than that of their bipartisan Senate colleagues, and almost certainly one that a critical mass of Democrats will reject.
In exchange for a two-year extension of CSR reimbursements to insurers to head off premium spikes and abandonment of insurance exchanges, Hatch and Brady would suspend enforcement of Obamacare’s individual and employer mandates even longer, while expanding the GOP’s pet health-care panacea of health savings accounts to help people pay out-of-pocket for their own care. It’s hard to imagine many Democrats going along with this strategic gutting of Obamacare provisions, since these steps will shrink insurance risk pools and force up premiums as much as or more than Trump’s cancellation of CSR payments did.
As Dylan Scott points out, Hatch and Brady could if they wanted to pretty much doom any adoption of the Alexander-Murray bill no matter what Trump or the other big nay-sayer Paul Ryan said. But their own proposal is really problematic, and not just because of its health-care provisions.
Hatch-Brady also picks up the so-called “Hyde language” seeking to prevent the use of federal subsidies — specifically in this case CSR payments — for insurance policies that cover abortions, as they are required to by state law in California, New York, and Oregon. Such provisions are one of the two demands (the other being “defunding” of Planned Parenthood) anti-abortion groups have been making of Republicans all year long as they struggled to repeal Obamacare. With the failure of that effort, these demands are migrating to whatever relevant legislation happens to pop up that the party they largely control, the GOP, is offering. Hatch-Brady is one of those. And it’s another reason the proposal is not going to fly as a substitute for the truly bipartisan Alexander-Murray bill.
Perhaps Hatch-Brady is just a bargaining gambit that will lead to a slightly more conservative version of Alexander-Murray. But now that they’ve caved to the RTLers on their own proposal, it’s extremely unlikely they’ll be able to un-cave when it comes to anything else. So it’s without question a large boulder in the path of Obamacare stabilization, and likely a poison pill designed to kill off the whole bipartisan effort.