Congressional Budget Office

Washington – After Sen. John McCain pointed his right index finger in a downward motion to register the decisive no vote that killed a GOP bill aimed at repealing the Affordable Care Act, Senate Minority Leader Chuck Schumer, with a wave of his arm, signaled Democrats who wanted to clap and cheer to stay silent.

Schumer knew that the ACA is in trouble, that rising premiums, the flight of insurers from state exchanges and other problems was weakening Obamacare and Democrats would need support from Republicans to help fix the nation’s health care system. It was no time to pour salt into fresh wounds.

After the vote, Democrats, including Connecticut Sens. Richard Blumenthal and Chris Murphy, joined Schumer and other fellow Democrats in calling for bipartisan efforts to shore up the ACA.

“Now we have an amazing opportunity for Republicans and Democrats to actually work together to keep what’s working in the Affordable Care Act and improve what’s not working,” Murphy said.

Blumenthal said, “We must now come together, reaching across partisan divides.”

On Friday morning, Schumer. D-N.Y., spoke with House Speaker Paul Ryan about doing something insurers say will help stabilize the market for individual insurance policies that are at the center of Obamacare.

Senators Richard Blumenthal, left, and Chris Murphy file photo

Insurers want assurances the federal government will continue to pay cost-sharing reduction subsidies that lower the cost of co-pays and deductibles for lower-income Americans who purchase policies on state exchanges like Connecticut’s Access Health CT.

Ryan had sued in court to stop those payments, saying they had never been appropriated and were being paid illegally by President Obama out of Department of Health and Human Services funds. President Donald Trump continued these payments to insurers but has not given them a guarantee they’ll continue.

Nevertheless, Schumer was optimistic.

“The insurance industry, hardly our allies, said one way to keep premiums down is to have cost-sharing permanent,” Schumer said.

Schumer said he would try to make those payments permanent “in the budget negotiations or elsewhere,” and the proposal “will have bipartisan support.”

That remains to be seen.

After the collapse of the GOP’s effort to repeal the ACA in the pre-dawn hours Friday, a grim Senate Majority Leader Mitch McConnell said “bailing out insurance companies with no thought of any kind of reform is nothing I want to be a part of.”

The two remaining insurers in Access Health CT, Anthem and ConnectiCare, said their decision to continue selling policies on the exchange will be based in large part on the continuation of the cost-sharing payments.

Cynthia Cox, the Kaiser Family Foundation’s associate director for health reform and private insurance, said there’s a chance congressional Republicans will have a change of heart over the cost-sharing payments since they were included in GOP legislation approved by the House and bills that failed in the Senate to repeal Obamacare.

“That would take it out of the Trump administration’s hands,” Cox said.

She also said that Health and Human Services Secretary Tom Price may back the idea of reinstating a federal ACA reinsurance program that protected insurers from high-cost claims during 2014, 2015 and 2016. Price has supported state-based reinsurance programs that were implemented in Alaska and Minnesota  — but he also says responsibility for health care should be shifted from the federal government to the states.

Other than that, Cox said, “there are very few areas of bipartisan overlap.”

A collapse of the state exchanges would mean an end of federal subsidies to low- and moderate-income Americans who purchase individual coverage through that marketplace. About 100,000 Connecticut residents are covered though Access Health CT and about 74,000 of those individuals receive subsidies.

Insurers are expected to make decisions on whether to quit Access Health after the Connecticut Department of Insurance rules on their rate increase requests at the end of August. Anthem is seeking an average 33.8 percent increase on plans covering individuals and their families and ConnectiCare has asked for an average rate hike of 15.2 percent on policies it sells through the exchange.

Even if the insurers leave Access Health, the ACA’s expansion of Medicaid, which extended the program to about 200,000 low-income individuals in Connecticut, would remain. So would the requirements that insurers provide a comprehensive array of benefits, cover those with pre-existing conditions, keep children on their parent’s policies until they are 26 years old, and eliminate lifetime benefit caps.

U.S. Rep. Jim Himes file photo

With the survival of the ACA, the mandate that nearly all individuals have insurance coverage and another requirement that businesses with 50 or more full-time employees cover their workers also remain.

But there’s concern the Trump administration won’t enforce that mandate. Under the ACA, those who don’t comply with the individual or business mandate must pay a tax penalty.

“There’s still a lot of room for the Trump administration to weaken those mandates,” Cox said.

One way is to expand the “hardship exemption” that allows those who say they can’t afford coverage to remain uninsured,” Cox said.

Rep. Jim Himes, D-4th District, leader of a centrist New Democrat Coalition, released an Obamacare repair plan that included guaranteed cost-sharing payments and reinsurance.

It also called for additional premium subsidies based on age and geography as well as income and considering allowing younger Americans to purchase stripped down insurance plans.

“At this point, the future is unclear. But that’s a good thing,” Himes said. “It means there are still options and opportunities for Congress to build on last night’s momentum in the coming months and take action that will benefit everyone. It’s time for real cooperation.”

Trump indicated he’d rather things get worse before they get better.

“As I said from the beginning, let ObamaCare implode, then deal. Watch!” he tweeted after the Senate vote.

Democrats have criticized his administration for ending outreach to Americans to enroll in the ACA and instead making videos distributed through social media that feature patients and doctors talking about the health care law’s shortcomings.

McCain on Friday said the failed vote on the Obamacare repeal “presents the Senate with an opportunity to start fresh.”

He called for the Senate Health, Education, Labor and Pensions (HELP) Committee, “to work together in a bipartisan fashion to craft a bill that increases competition, lowers costs, and improves care for the American people.”

Murphy, a member of the HELP committee, said, ” I think Republicans are going to have to agree to the same goals as Democrats, which is more people having insurance than less people having insurance.”

He said there’s “room to doubt” that the GOP shares that goal since the bills it has introduced in the House and Senate have been determined by the Congressional Budget Office to result in 16 million to 26 million more uninsured Americans.

Murphy also said Democrats need to walk into negotiations with Republicans knowing they have to give something to get something in return.

“(Under the ACA) only young people have been able to have catastrophic plans. I think we can let more people have catastrophic plans,” he said. “I don’t want Democrats to think we can want a public option (a government-run health insurance policy option) and not give Republicans something they want. This has to be a real negotiation.”

Murphy also said, “It’s not like Republicans are going to capitulate to all our demands after last night.”

Schumer said the Republican and Democratic House and Senate leaders could work together, but Trump stands in the way.

“I think the four leaders left to their own devices along with their caucuses could get a lot done, but there are outside forces that pull things apart,” Schumer said. “The president has not been helpful in bringing people together.”

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Ana has written about politics and policy in Washington, D.C.. for Gannett, Thompson Reuters and UPI. She was a special correspondent for the Miami Herald, and a regular contributor to The New York TImes, Advertising Age and several other publications. She has also worked in broadcast journalism, for CNN and several local NPR stations. She is a graduate of the University of Maryland School of Journalism.

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