New health care ideas formulating, but path to passage still unlikely

Republican, Democratic and even bipartisan plans for reshaping parts of the Obama health care law are proliferating in Congress. But they have iffy prospects at best, and there were no signs Monday that GOP leaders have chosen a fresh pathway after last week's collapse of their struggle to repeal and rewrite the statute.

Despite a weekend of tweets from President Donald Trump insisting that the Senate revisit the issue, Republican prospects for garnering 50 votes to push something through the chamber seemed to worsen after Sen. John McCain returned to Arizona for brain cancer treatments. He was among three GOP senators who joined Democrats in opposing a bare-bones bill rolling back a few pieces of President Barack Obama's statute, dealing it a stunning 51-49 defeat, and his absence probably denies leaders their best chance of turning that vote around.

Rather than resuming its health care debate, the Senate began considering a judicial nomination Monday.

In the House, 43 Democratic and Republican moderates proposed a plan that includes continuing federal payments that help insurers contain expenses for lower-earning customers and limiting Obama's requirement that larger employers offer coverage to workers. But movements by House centrists seldom bear fruit in the House, where the rules give the majority party ironclad control, and Speaker Paul Ryan, R-Wis., offered little encouragement.

"While the speaker appreciates members coming together to promote ideas, he remains focused on repealing and replacing Obamacare," said Ryan spokeswoman AshLee Strong.

The House approved its health care overhaul in May after barely overcoming its own GOP divisions.

Mr. Trump has threatened anew in recent days to cut off the payments to insurers, which total $7 billion this year and are helping trim out-of-pocket costs for 7 million people. White House adviser Kellyanne Conway said Trump will decide this week whether to pay them in August, and insurers have cited the monthly uncertainty as a factor in rising premiums.

As Mr. Trump also called for an end to "bailouts for insurance companies", CBS News' Nancy Cordes reports that about six million Americans on the individual market still benefit from the cost-sharing funds issued to insurers. 

The Kaiser Family Foundation (KFF) found that insurers would need to hike their average premiums an additional 19 percent by next year to compensate for the lost funding. 

Larry Levitt, Vice President of KFF told CBS News that "Insurers really have two choices if these payments stop. One is to increase premiums, the other is to exit the market completely."

He added, "if insurers decide that this kind of undermining of the market is going to continue and they exit the market entirely, that could leave millions of people uninsured with no other options."

House Minority Leader Nancy Pelosi, D-Calif., said GOP leaders should "follow the example of their members releasing some proposals with Democrats today" and engage in "serious bipartisan conversations," but she didn't specifically endorse the bipartisan proposals.

The group was led by Reps. Tom Reed, R-N.Y., and Josh Gottheimer, D-N.J. One proposal would require companies with at least 500 workers to offer coverage, up from the Obama law's cutoff of 50 workers.

Hoping to find some way forward, health secretary Tom Price was meeting with some governors and at least one senator, Louisiana Republican Bill Cassidy, congressional and statehouse aides said. Among those attending was Republican Arizona Gov. Doug Ducey, who's been trying to defend his state's expansion of Medicaid, the health insurance program for poor people, against proposed GOP cuts.

Price said last week that the administration would advance its health care goals using regulations that Congress does not have to approve.

Cassidy and Sens. Lindsey Graham, R-S.C., and Dean Heller, R-Nev., have proposed converting the $110 billion they estimate Obama's law spends yearly for health insurance into grants states could use for health programs as they see fit.

Shortly after the Senate rejected his last-ditch bill Friday, Majority Leader Mitch McConnell, R-Ky., invited Democrats to present their ideas on the issue. But he quickly constructed an obstacle for one top Democratic desire: continuing the payments to insurers.

"Bailing out insurance companies with no thought of any kind of reform is not something I want to be part of," McConnell said.

Obama's statute requires that insurers reduce those costs for low-earning customers. Kristine Grow, spokeswoman for the insurance industry group America's Health Insurance Plans, said Monday that halting the federal payments would boost premiums for people buying individual policies by 20 percent.

Besides continuing those payments, Senate Minority Leader Chuck Schumer, D-N.Y., has pushed two other Democratic proposals.

Under one by Sens. Tim Kaine of Virginia and Tom Carper of Delaware, the federal government would help pay larger than expected claims for insurers providing coverage on the federal and state online marketplaces established by Obama's law.

Another by Sen. Clare McCaskill of Missouri would let people in counties where no insurers offer policies on exchanges buy the same coverage that members of Congress purchase. The federal Centers for Medicare and Medicaid Services estimated last week that exchanges would offer no coverage next year in 40 of the country's roughly 3,000 counties.

Tennessee's two GOP senators — Lamar Alexander and Bob Corker — have suggested legislation that would let people in counties without available coverage on their exchanges to use the Obama law's tax credits to buy individual policies outside of those marketplaces.