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As Trump mulls cutting off Obamacare aid, Senate begins bipartisan approach

Even as President Trump renews his threat to undermine the Affordable Care Act, senior Republican and Democratic senators announced plans Tuesday to begin work on a new bipartisan effort to stabilize the 2010 healthcare law, often called Obamacare.

The move — by Senate Health Committee Chairman Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.), the committee’s senior Democrat — does not ensure the end of the GOP’s long Obamacare repeal campaign.

But in the wake of last week’s dramatic collapse of the Senate GOP repeal effort, it signaled a new willingness by Republican senators to begin work on fixing weaknesses in the current law rather than trying to roll it back.

Senate Majority Leader Mitch McConnell (R-Ky.) underscored that message Tuesday morning in a statement and a series of messages on Twitter in which he set out the schedule for the Senate for the rest of August.

On the list was confirming nominees, legislation to help veterans and the reauthorization of user fees that pay for a large chunk of the Food and Drug Administration. Notably missing was healthcare.

The effort by Alexander and Murray will begin with a series of hearings starting the week of Sept. 4, Alexander said Tuesday, announcing his interest in finishing legislation by the end of the month to head off potentially large insurance rate hikes for 2018.

“Any solution that Congress passes for a 2018 stabilization package would need to be small, bipartisan and balanced,” he said as he invited the committee’s Democrats to participate in the process.

The Senate hearings could complement a bipartisan effort in the House, where a group of Republicans and Democrats — who have called themselves the Problem Solvers Caucus — have begun meeting to talk about fixes to the current law.

Most patient advocates, physician groups, hospitals and even many health insurers have been saying for months that targeted fixes to insurance marketplaces make more sense than the kind of far-reaching overhaul of government health programs that Republicans had been pushing.

The marketplaces, though a pillar of Obamacare, represent a small part of the U.S. healthcare system with just about 10 million people getting coverage there.

But rate hikes and the decision by many insurers to exit markets amid the current political uncertainty in Washington has threatened consumers’ access to health plans.

Most independent experts, industry officials and state regulators say stabilizing the markets and controlling premium hikes would actually be relatively straightforward.

One critical step is funding assistance through Obamacare to low-income consumers to help offset their co-pays and deductibles.

This aid — known as cost-sharing reduction, or CSR, payments — was included in the original law.

But the payments have become a political football as Republicans during the Obama administration successfully argued in federal court that the aid can’t be provided without an appropriation by Congress. That ruling has been on hold for months.

Now Trump administration officials are threatening to cut off the payments, a threat the White House renewed after last week’s Senate votes.

Congress could simply put an end to that uncertainty by voting to appropriate the CSR money, an idea supported by many lawmakers.

Alexander said Tuesday that he asked the president to continue funding the CSR payments for August and September to give Congress time to appropriate the money going forward.

Supporters of continuing the payments got a boost late Tuesday when a federal appeals court in Washington allowed Democratic state attorneys general to join the continuing court arguments over the money. Now that the attorneys general are formally in the case, they would be able to quickly go to court to defend the payments if the administration tried to cut them off.

Most insurance experts and officials also say the federal government must create a better system to protect insurers from big losses if they are hit with very costly patients.

Such reinsurance systems are already used in other insurance marketplaces, such as the Medicare Part D prescription drug program, and are seen as critical to stabilizing markets.

Whether enough congressional Republicans will ultimately back such an effort to stabilize insurance markets remains unclear.

Many GOP lawmakers continue to be interested in rolling back Obamacare and dramatically cutting funding for healthcare safety net programs such as Medicaid.

Three Senate Republicans — Bill Cassidy of Louisiana, Lindsey Graham of South Carolina and Dean Heller of Nevada — have been talking about a whole new repeal plan with the White House in recent days.

And Tuesday, Sen. Mike Rounds (R-S.D.) warned that many Republicans are unlikely to vote for a bill that simply commits more federal money to Obamacare insurance markets.

“There has to be some sense of moving in the right direction in regard to some reform or I don’t think you’ll have the House and the Senate and the president agreeing,” he said.

But the appetite for a new repeal push seems limited among GOP congressional leaders at the moment.

And Republicans face mounting political pressure not to let the current law collapse. Polls indicate that Americans now hold congressional Republicans and the Trump administration responsible for the fate of the nation’s healthcare system, including the insurance marketplaces.

"There's just too much animosity and we're too divided on healthcare," Sen. Orrin G. Hatch (R-Utah), the head of the Senate Finance Committee, said of the future prospects of repeal in an interview Monday with Reuters.

"I think we ought to acknowledge that we can come back to healthcare afterward, but we need to move ahead on tax reform," Hatch said.

His remarks were quickly followed by others in GOP leadership positions.

"I think it's time to move on to something else," Sen. Roy Blunt of Missouri told CNN. "If the question is do I think we should stay on healthcare until we get it done, I think it's time to move on to something else."

Sen. John Thune of South Dakota also chimed in. "Until someone shows us how to get that elusive 50th vote, I think it's over," he told reporters.

The remarks seemed a coordinated effort to respond to administration officials, including budget director Mick Mulvaney and Health and Human Services Secretary Tom Price, who said over the weekend that they wanted the Senate to keep working on healthcare.

And few GOP senators appear to support Trump’s threats to cut off the CSR payments, which could send insurance premiums skyrocketing, particularly for middle-income Americans who make too much to qualify for subsidies under the healthcare law.

A growing number of Republican lawmakers have called on Trump not stop the payments.

Lisa Mascaro in Washington contributed to this report.

Obamacare vs. Trumpcare: A side-by-side comparison of the Affordable Care Act and the GOP’s replacement plan »

Obamacare 101: A primer on key issues in the debate over repealing and replacing the Affordable Care Act. »

noam.levey@latimes.com

@noamlevey

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UPDATES:

6:55 p.m.: This article was updated with information on an federal appeals court ruling.

2:25 p.m.: This article was updated with reaction from Sen. Rounds.

This article was originally published at 12:25 p.m.

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