The compromise from Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., would provide states with greater flexibility under the Affordable Care Act in exchange for authorizing cost-sharing reduction payments known as CSRs for two years. Those payments help offset deductibles and other out-of-pocket costs for low-income consumers who obtain insurance under the ACA.
Trump insisted he’d been involved in crafting the deal. (Then Obamacare wasn’t dead?) Republican lawmakers, however, haven’t signed on since they’ve been touting their determination to destroy Obamacare, not to save it. On the other hand, if they don’t accept the Alexander-Murray deal (which Senate leadership squashed to push the Graham-Cassidy replacement scheme), they’ll be blamed for making insurance premiums even more costly and leaving more Americans without coverage. Welcome to the Trump era in which Republicans wind up contradicting themselves and holding the bag - and their noses - because the president is committed only to preserving his ego and claiming a win.
We might - get this - see the president demand Republican leadership move the compromise plan to the floor where “Chuck and Nancy” (Senate Minority Leader Charles E. Schumer of New York and House Minority Leader Nancy Pelosi of California) can round up the votes needed to pass it.
In a critical sign of support, Sen. Susan Collins, R-Maine, told Chuck Todd Tuesday afternoon, “I’m very pleased that Lamar Alexander and Patty Murray continue to work so hard to try to stabilize the insurance markets, to lower premiums, and to provide some stability, which is really needed. This bill may not be perfect. I would have liked to have seen a specific authorization and some seed money for reinsurance pools, which would further help to lower premiums. But this is a good package, and I hope it will be passed very quickly so it can have an impact on rates this year.” She’ll need to bring a number of Republicans with her and prevail upon the majority leader to put it to a vote.
On one level this shows how entirely unprincipled and reckless have been the president’s actions. One day he’ll destroy coverage, the next he might spare it. The content of bills and their affect on actual people makes no difference to him. The current situation also speaks to the intellectual dishonesty and vapidity of Republicans who inveigh against Obamacare, cannot come up with a popular alternative and then would (in some cases) rather see vulnerable citizens hurt than fix some of the problems with the ACA and buy more time for further revisions.
Defenders of Obamacare and fierce critics of Republicans effort to kill it were delighted with the Alexander-Murray agreement. Andy Slavitt of the Bipartisan Policy Center and the former head of CMS praised the bipartisan effort to retain coverage in lieu of “partisan efforts which reduce coverage, cut Medicaid, and diminish patient protections.” He explained:
“They have reached an agreement which preserves the ACA entirely while accomplishing three things. First, it undoes some of the harmful effects of the Trump Administration’s actions by restoring CSR payments and outreach funding for the next two years, although other harmful actions by the Administration also need to be addressed. Second, it provides new health plan options and added state flexibility while maintaining important consumer protections. And third, it represents a down payment on additional bipartisan reforms to increase the affordability of coverage for Americans.”
In a similar vein, Schumer commended the agreement insofar as it “stabilizes the system” with two years of CSR payments. He suggested, “Our Republican colleagues seem to be in the opposite place on the long-term, but I think there’s a growing consensus that in the short-term we need stability in the markets.”
That’s the bitter pill Republican now will need to swallow - or not. Having failed to craft a workable GOP alternative to Obamacare, they might indeed have to keep it running until such time as they might come up with a feasible replacement. Considering what we’ve seen this year and their prospects for the 2018 midterms, “such time” may be never.
Jennifer Rubin is a Washington Post columnist.