This is the web version of VoxCare, a daily newsletter from Vox on the latest twists and turns in America’s health care debate. Like what you’re reading? Sign up to get VoxCare in your inbox here.
So what can we actually expect Congress to do about Obamacare when the House and Senate come back next month? I've heard a couple of things in recent weeks that should help paint a picture of the challenges any bipartisan bill will face.
First, one health care lobbyist who had spoken recently with Republican staff told me there's a real fear that if Congress were to pass a bill to stabilize the Obamacare markets, President Trump would veto it.
Then at a briefing I attended with congressional health staffers earlier this week, the discussion ended with speculation about whether a package could be put together with enough support to override a presidential veto.
"Presumably what the [Senate health] committee is working on, if it is truly bipartisan, could potentially make the president’s signature irrelevant," one senior Democratic aide said. "Just depends on how many people you have supporting it."
So we are off to a great start.
But another factor complicates this even further: Cassidy-Graham-Heller, the last plan standing to repeal and replace Obamacare.
The hope for any actual action in September — and there is abundant skepticism around Washington that such action is possible — depends on many conservatives at the Capitol letting go of their Obamacare repeal dreams while at least one plan to overhaul the law is still drawing breath. The proponents of a bipartisan solution will have to convince them to set that aside and come into the fold.
The Senate health committee has made clear, in its choice of witnesses for hearings on September 6 and 7, that members really are seeking some third way forward on the law.
Governors from Massachusetts, Ohio, Tennessee, Utah, and Colorado will attend. Four Republicans and one Democrat. Three Medicaid expansion states and two non-expansion states. It's as centrist as you can get. Those same traits can be found in the state insurance commissioners who were asked to attend.
But transitioning suddenly — and on a tight timeline, with action likely needed before a late September deadline for the 2018 Obamacare marketplaces — from the scorched-earth partisan warfare of the past seven years to some kind of bipartisan compromise is going to be a huge concession for conservatives.
That's why Cassidy-Graham, which Sarah explained in great detail, is lingering. GOP leadership has shown no interest, but the rank-and-file conservatives who campaigned for years on repealing Obamacare know it's still out there, and they're curious.
As Sen. Bill Cassidy (R-LA) rightly put it, it's "the only game left in town." The Freedom Caucus chair is interested. So is the White House, where Trump still hasn't let go of the failure of Obamacare repeal, as he reminded us just yesterday.
We’ve even picked up on rumors that the senators are trying to get their ducks in a row for an early September rollout of Cassidy-Graham — the very same week that the health committee is holding its stabilization hearings.
Here's my point: Serious people in Washington are already talking about the possibility that a stabilization bill needs to be veto-proof. It's going to be hard to win such an overwhelming majority — two-thirds of both the House and the Senate — when you still have this distraction that promises a path toward repeal.
Or to put it in one image:
Chart of the Day
Somebody alert Dean Heller. The left-leaning CBPP did its best to evaluate Cassidy-Graham, using what we know about the not-quite-yet-finalized bill and previous CBO estimates. The chart tells the story: deep cuts to health care spending, including Medicaid. Which makes it all the stranger that Sen. Dean Heller (R-NV), who opposed previous Republican bills over Medicaid cuts, has lent his support to this plan.
With research help from Caitlin Davis
Today's top news
- "New York’s largest hospital system Is closing its insurance business": “Citing financial losses wrought by inaction and uncertainty in Washington, New York State’s biggest hospital system is shuttering its four-year-old health insurance division that sold coverage, some of it via Obamacare. The division, CareConnect Insurance Co., insures 126,000 New Yorkers who will have to purchase coverage elsewhere when the hospital system, Northwell Health, phases out its insurance operation next year.” —Sarah Maslin Nir, New York Times
- "Maryland health insurers to announce rates after hike request": “There are two carriers left selling Obamacare plans in the state after three exited the market, and the Maryland Insurance Administration is expected to announce Friday how much they will be allowed to charge. The state’s dominant insurer CareFirst BlueCross BlueShield requested an average 52 percent increase in premiums next year. Kaiser Health Plan of the Mid-Atlantic asked for an average increase of about 25 percent.” —Meredith Cohn, Baltimore Sun
- "South Carolina governor cuts off funding for abortion clinics in executive order": “South Carolina Gov. Henry McMaster (R) demanded that state agencies cut off state and local funds to abortion clinics in an executive order Friday. The order directs state agencies to cease providing funds, whether via grant, contract, state-administered federal funds or "any other form," to any abortion clinic.” —Jessie Hellmann, the Hill
- "California lawmakers to hold universal healthcare hearings": “[Speaker of the CA Legislature Anthony] Rendon says he supports universal health care but couldn't move the Senate bill forward because it lacked key details about how the system would function and how it would be funded. 'I don't think we've at all had anything close to approaching an honest discussion about single payer,' he said. 'This is an attempt to have a serious discussion.'” —Associated Press
Analysis and longer reads
- "The implications of the opioid lawsuits": “It's not at all clear municipalities will win, but the lawsuits represent something larger — policymakers want more scrutiny and oversight for companies that make and deliver painkillers instead of heaping blame on people who suffer from addiction.” —Bob Herman, Axios
- "Failure of Obamacare repeal shows passing single-payer would be harder than we thought": “The idea that government has a role in making sure individuals have coverage, it seems, has taken hold in both parties. But looked at another way, the GOP failure actually shows what an uphill battle it would be for Democrats to pass single-payer healthcare.” —Philip Klein, Washington Examiner
Join the conversation
Are you an Obamacare enrollee interested in what happens next? Join our Facebook community for conversation and updates.