Despite broad support from consumer advocates, state officials and healthcare leaders across the country, a bipartisan effort in Congress to stabilize health insurance markets and control rising premiums is being threatened by resurgent political fighting over the Affordable Care Act.
With time running out before millions of Americans could be subject to major rate hikes, it is increasingly unclear if Congress will be able to come together to offer relief.
On Wednesday, dueling new proposals from the right and left underscored partisan differences over health policy.
Four GOP senators — led by Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina — introduced a sweeping bill to replace the 2010 healthcare law, often called Obamacare, and called on Congress to pass it by the end of the month.
And 15 Senate Democrats lined up behind a bill by Sen. Bernie Sanders (I-Vt.) to move toward a "single-payer" model of healthcare in which nearly all Americans would get government health insurance akin to Medicare.
In contrast to these deeply divisive proposals, the bipartisan healthcare push in the Senate Health Committee — spearheaded by Chairman Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.), the senior Democrat — had spawned an unusual outbreak of harmony between Republicans and Democrats over the last several weeks.
And it fueled hopes that after seven years of bitter partisan fighting over the 2010 healthcare law, the two parties might be able to work together to help Americans burdened with rising healthcare costs.
The committee has been looking for ways to help consumers who get health insurance on their own, rather than from an employer or a government program such as Medicare and Medicaid.
These consumers, many of whom do not qualify for government assistance, have seen double-digit premium increases in recent years and could see even higher rates next year, driven in part by Trump administration moves that are undermining markets.
To stabilize the markets, which serve about 20 million people, Republicans and Democrats on the health committee have voiced support for continuing monthly payments to insurers that help them offer lower copays and deductibles to millions of low-income consumers.
The uncertainty over these so-called cost-sharing reduction payments — which the Trump administration has repeatedly threatened to withhold — has prompted numerous insurers around the country to warn that they must raise premiums by double digits next year to account for the possibility that they won't get the federal assistance.
Governors and state insurance regulators from both parties as well as insurance industry officials have called on Congress to end the uncertainty.
Tennessee's regulator, Republican Julie McPeak, last week told the Senate health committee that ensuring consistent cost-sharing payments is "the single most important issue" to stabilizing markets.
Senators from both parties also have expressed interest in setting up new systems to protect insurers from big losses if they are hit with very costly patients.
Such reinsurance systems are used in other marketplaces such as the Medicare Part D prescription drug program and are seen as critical to controlling premiums.
But several senior Republicans — including Senate Finance Committee Chairman Orrin Hatch (R-Utah) — have derided additional cost-sharing payments as a "bailout" for the insurers.
And many GOP lawmakers are demanding that Congress agree to give states greater flexibility to waive requirements in the 2010 healthcare law dictating minimum standards for what health insurance should cover.
"There still are significant differences to deal with," Alexander warned this week, noting the importance to Republicans of granting states more power, which many conservatives believe could help lower costs.
"A true compromise requires Democrats to accept something that Republicans want — more flexibility for states — and Republicans to accept something that Democrats want — continued funding for cost-sharing payments in the Affordable Care Act," Alexander said.
But Democrats and many consumer advocates worry that weakening insurance standards in the current law could make insurance more difficult to get for sicker Americans.
"Democrats will reject any effort to use this discussion as a way to erode the guardrails and protections that so many patients and families rely on," Murray warned.
While debate over the future of consumer protections in the current law intensifies, partisan healthcare efforts are again proliferating on Capitol Hill.
Sanders' single-payer bill, while popular with liberals, is vehemently opposed on the right.
And the last-ditch GOP effort to resuscitate the campaign to roll back the Affordable Care Act has stoked new ire among Democrats and many patient advocates.
The cornerstone of the Cassidy-Graham bill is a sweeping overhaul in the way the federal government provides hundreds of billions of dollars of healthcare assistance to low- and moderate-income Americans. That threatens health coverage for tens of millions of people, advocates warn.
The prospects for both efforts appear dim.
House Minority Leader Nancy Pelosi (D-San Francisco), a leading liberal, dismissed Sanders' bill this week, saying her immediate goal is to protect the Affordable Care Act from President Trump's efforts to dismantle it.
And although Trump praised Cassidy and Graham for offering their new proposal Wednesday, Senate GOP leaders are not rushing to embrace it.
Sen. John Thune (R-S.D.) compared the bill's chances for passage to "a double bank shot."
The GOP has less than three weeks before authorization expires to use a special procedure to advance repeal legislation with only 50 votes. "I think that's just really, really hard," Thune said.
Alexander said he hopes he and Murray will be able to develop some compromise by the end of next week.
Insurance rates for 2018 for many state marketplaces are supposed to be finalized by the end of this month.
Times staff writers Lisa Mascaro and Brian Bennett in Washington contributed to this report.
11:55 a.m.: This story was updated with new bills unveiled Wednesday and Trump's reaction.