The Senate early Friday morning adjourned for the weekend after the defeat of Senate GOP leaders' third and—for now—final health reform plan, leaving many questions unanswered about the future of Medicaid and the health care system.
According to the Washington Post's "PowerPost," Senate Majority Leader Mitch McConnell (R-Ky.) on Friday morning pulled the House-passed American Health Care Act from consideration. McConnell in a floor speech following the vote said "it is time to move on." He said, "This is clearly a disappointing moment. ... I regret that our efforts were simply not enough, this time."
The Senate, according to Roll Call, is scheduled to reconvene at 4 p.m. Monday, when "PowerPost" reports senators will set up votes on judicial nominations.
But several key questions remain about the future of the Affordable Care Act—the most time sensitive of which is whether the Trump administration will continue making the law's cost-sharing reduction payments to insurers.
A bipartisan way forward?
Though McConnell suggested the Senate would move on from health reform, he also signaled that Republicans could take a bipartisan approach, saying of Democrats, "Now I think it's appropriate to ask, what are their ideas? It would be interesting to see what they suggest as the way forward."
Several senators from both sides of the aisle signaled a willingness to move forward on a bipartisan plan, but said those efforts should start in committee.
For instance, McCain, who cast a deciding vote against Friday's measure, called for a "return to the correct way of legislating," saying the Senate should "send the bill back to committee, hold hearings, receive input from both sides of the aisle, heed the recommendations of the nation's governors, and produce a bill that finally delivers affordable health care for the American people."
Sen. John Thune (R-S.D.) and Senate Health, Education, Labor and Pensions (HELP) Committee Chair Lamar Alexander (R-Tenn.) suggested that Democratic and Republican lawmakers could work together in committee to pursue health care changes. Separately, Politico reports that a bipartisan group of House lawmakers have been meeting for about a month to discuss potential health reform changes, although a lawmaker familiar with the meetings declined to share details.
However, hours after Friday's vote failed Rep. Mark Meadows (R-N.C.) said he has spoken with several GOP senators about a potential new deal that would include proposals offered by Sens. Lindsey Graham (S.C.), Bill Cassidy (R-La.), Ted Cruz (R-Texas), and Rob Portman (R-Ohio). Meadows said, "We will continue to do that over the next couple of weeks on a plan that can get to 51" votes in the Senate.
Democrats have some internal health care divisions
While Senate Democrats have been highly critical of the way McConnell sought to pass a health reform bill, as a party they have yet to coalesce around a clear set of priorities to improve the health care system going forward, The Hill reports. A task force of 10 House Democrats earlier this month released a health care proposal that aims to stabilize the Affordable Care Act's (ACA) exchange market and lower exchange plan premiums, but the proposals were not fully endorsed by House Minority Leader Nancy Pelosi (D-Calif.).
Meanwhile, President Trump shortly after the vote reiterated his calls to "let ObamaCare implode."
Cassidy, who also signaled an openness to bipartisan health reform proposals, called Trump a "wildcard," saying, "Obviously the president, through executive action, can make things ever more difficult. And that's a possibility."
Here are five key ways the Trump administration could influence health policy:
1. Keep—or stop—making cost-sharing reduction subsidies
The Trump administration has been making these payments, which the ACA created to help offset care costs for low-income exchange enrollees, on a monthly basis, and the next one is due in three weeks, Politico's "Pulse" reports. But Trump has not given any indication on whether the administration will make that or future payments. The administration also effectively could halt the payments by dropping the White House's appeal of a case challenging the payments.
2. Halt enrollment outreach
HHS Secretary Tom Price will need to decide whether he will promote ACA enrollment efforts for the next open enrollment period. The administration earlier this month terminated two contracts that supported ACA enrollment outreach efforts in 18 cities.
3. Suspend enforcement of the individual mandate
Trump cannot unilaterally eliminate the ACA's mandate that individuals purchase insurance or pay a penalty, but he could take measures to weaken its enforcement. For instance, IRS in February indicated it would continue accepting tax returns that do not indicate filers' health coverage status.
4. Change the generosity of premium tax credits
The Trump administration in February proposed a rule that would change the actuarial levels—the percent of an individual's health care costs a plan would cover—that plans in each metal tier must meet. According to the Center on Budget and Policy Priorities, this change would also affect the amount of premium tax credits exchange plan enrollees receive to help cover the cost of coverage "because it would lower the standards for 'silver' plan coverage."
5. Approve state waivers requests for Medicaid
The Trump administration has encouraged states to submit waivers to change their Medicaid programs by implementing initiatives such as work requirements (O'Keefe et al., "PowerPost," Washington Post, 7/28; Roll Call, 7/27; Roubein/Hellmann, The Hill, 7/28; Park/Sanger-Katz, New York Times, 4/12; Demko, Politico, 7/28; Nather/Baker, "Vitals," Axios, 7/28; Livingston, Modern Healthcare, 7/26; Hellmann, The Hill, 7/12; Ferrechio, Washington Examiner, 7/28; Aron-Dine/Park, Center on Budget and Policy Priorities, 2/15).
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