Postcard from the Hill: Senators shelve histrionics in search of Obamacare fix

Sep 13 2017

After a summer of flame-throwing over the Affordable Care Act's repeal, Republicans and Democrats are now engaged in a serious collaborative effort to find a legislative solution that would ward off predicted premium rate hikes this year.

Sen. Lamar Alexander, who chairs the Senate Health, Education, Labor and Pensions (HELP) Committee, and his colleagues are up against a tight deadline to craft a bill to steady premiums in the Affordable Care Act's shaky markets. Insurers must nail down plans late this month for the coming enrollment season.

If that weren't challenging enough, the Tennessee Republican and the committee's ranking Democrat, Sen. Patty Murray of Washington, have insisted their bill also be simple, bipartisan and balanced.

Two much-discussed ideas so far are funding subsidies that help moderate-income consumers pay out-of-pocket costs for health care and giving states more leeway on insurance coverage and plans for their residents.

Over three hearings in two weeks, senators solicited ideas and insights from bipartisan panels of governors, state insurance commissioners, government researchers and insurance company executives. Before the hearings, there were informal "coffee sessions" so that non-committee members from both parties could drop by to ask questions.

Noticeably absent: Democratic press conferences griping about the Republicans' failure to permit hearings or seek input on their plans to repeal and replace the Affordable Care Act, also known as Obamacare. Such public airings were a fixture last summer when a Republican task force chosen by Senate Majority Leader Mitch McConnell drafted a replacement bill that was defeated in late July.

Civility has ruled the HELP committee's hearings, kept them policy-focused — and mostly as dry as day-old toast. They are nearly incomprehensible to anyone but health policy experts.

On Tuesday, Alexander queried a witness about the nuances of segmenting invisible high-risk pools, and Sen. Sheldon Whitehouse (D-R.I.) asked about two types of reinsurance.

The committee's members are a cross section of each party's politics — from Sen. Rand Paul (R-Ky.) on the right to Sen Elizabeth Warren (D-Mass.) and Sen. Bernie Sanders (I-Vt.) on the far left.

But all 23 members get the same time to question witnesses — five minutes each. On occasion, Alexander is lenient with Democrats and Republicans alike, allowing them extra time to get detailed policy answers from witnesses.

There is no talk of death spirals, collapsing markets or sabotage — terms that colored past debates about Obamacare. Instead, HELP senators bat around the nuances of actuarial equivalence, budget neutrality and reinsurance programs.

"So far, we've had focused, substantive discussions in our first two hearings — and in our many conversations off the committee — on areas of significant common ground around these goals," Murray said in her opening statement Tuesday.

This atmosphere is the antithesis of the rancor that hung over the “repeal and replace” debates. Sen. Al Franken (D-Minn.), a former comedian, has even had time to joke with Republicans.

Partisan posturing hasn't been entirely missing at these hearings, though. Warren used some of her questioning time last week to denounce the Trump administration's threats to end reimbursements to insurance companies for the "cost-sharing reduction" discounts they provide to enrollees with incomes under 250 percent of the federal poverty level.

Sen. Bill Cassidy (R-La.) used his time to advocate for reducing federal spending on Medicaid.