The News:

The month of September has been blitzed with healthcare bills. Last week alone, Democrat and Republican senators introduced both a single-payer plan and an Affordable Care Act (ACA) repeal and replacement plan.

But the most important bill has yet to be released. Language to the only health bill that will immediately secure the ACA marketplace and relieve nearly 22 million people of stress next year–and a host of coverage providers–will be released soon.

The last of four hearings held by the Senate’s Health, Education, Labor and Pensions (HELP) concluded Thursday, according to ThinkProgress. After listening to testimonies from governors, insurance commissioners, and healthcare stakeholders more broadly, the HELP committee is writing legislation, scheduled to be released this week.

The bill–as promised by HELP Committee Chairman Lamar Alexander (R-TN)–will purposely be slim, with the aim of passing legislation without political gamesmanship. Lawmakers are pressed against a hard deadline of September 27, when insurers must sign final contracts for selling on the 2018 ACA marketplaces. The bill will likely include three legislative policy items:

• Committing to pay cost-sharing reduction (CSR) subsidies to insurance companies for at least a year;
• Letting older people on the marketplace buy catastrophic plans, which are cheap premium plans with high out-of-pocket costs; and
• Changes to state innovation waivers.

The first policy is largely uncontroversial, and every expert that has testified before the Senate HELP committee over the last two weeks has said the federal government should commit to paying these CSR payments. CSR payments are important because they’re one of two subsidies available to low-income people who receive coverage through the ACA.

The other is tax credits, which everyone isn’t eligible for. President Donald Trump has been deciding whether to make CSR payments to insurers on a month-to-month basis, which has infused stakeholders with high anxiety. As I have written previously, without payments, premiums on average would increase about 20%. (However, most ACA enrollees will be safeguarded due to subsidies.)

Alexander told reporters Thursday (September 14, 2017) that after this bill is passed, his committee will not be turning to long-term bipartisan ACA reform, but instead look at healthcare costs more broadly. The ACA only accounts for about 7% of the total healthcare market.

Steve’s Take:

(Loudspeaker) GOP contestants: Take your marks; get ready…(sound of starting gun); and they’re off!

What’s the event, you ask? It’s the finals of the dash to accomplish something–anything–that resembles the enactment of legislation relating to the GOP’s 7-year (so far) failed effort to repeal Obamacare.

Steve's Take: Who will win the #GOP race toward their failed effort to repeal #Obamacare?
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He had to see it coming, and it’s not as though Sen. Alexander didn’t face enough difficulties trying to craft a bipartisan bill to shore up, not scrap, Obamacare, but he’s taking unfriendly fire from one of his most powerful Republican collaborators–the other healthcare chairman, according to Politico.

Alexander is “stealing our jurisdiction,” Senate Finance Chairman Sen. Orrin Hatch said, referring to the territorial split between his panel and Alexander’s HELP Committee. “It’s pretty hard to get excited about what he’s doing.”

A group of Republican senators has tried desperately to make another effort to push their block-grant plan before their procedural powers to vote on a simple majority of 51 expires on Sept. 30. But that’s not the only deadline that matters. Insurance companies also have until the 27th to decide if they want to be part of the ACA marketplace in time for 2018.

Politico reported in an article titled: “GOP split over fixing or gutting Obamacare as deadline looms” that Sen. Ted Cruz (R-TX) echoed the same sentiment. Cruz claimed that Senate Republicans had 45-46 votes in the Senate, in response to Sen. Jeff Flake (R-AZ) who said that “he didn’t see it.”

Of course, Cruz is looking at the same number the GOP had before when they failed to even repeal the ACA, let alone replace it. The problem now is trying to convince Senate Majority leader Mitch McConnell to bring the block grant proposal to a vote, but 46 votes are still five votes short.

As reported above, however, there is a bipartisan effort to shore up the insurance markets between Sen. Alexander and Sen. Patty Murray (D-WA). But the Politico report said that there is already fallout between the leaders as the effort is triggering Republican arguments about “bailing out” insurance companies. In another Politico report mentioned below, there are signs of further fallout over Alexander’s efforts from within the Republican Party as well.

“Bailing out” insurance providers is an argument that Senate Majority Whip John Cornyn (R-TX) has made repeatedly, and lately, he suggested in that case that it would probably be better to not do anything at all. The bipartisan effort is said to fund the ACA’s cost-sharing program for two-years.

Sen. Alexander is hoping to have something to turn over to Senate Minority Leader Chuck Schumer and McConnell by the beginning of the week. It’s presumed at this rate that McConnell could continue to side with Republicans and scuttle Alexander’s bipartisan plan.

It was also reported on Sunday by Jon Mark at BlastingNews that Sen. Orin Hatch (R-UT) was siding with Cornyn’s view of “bailouts” and that he wrote his own Op-Ed for the Washington Post entitled; “Obamacare doesn’t deserve a bailout.”

In that piece, he went after Alexander saying the senator was “stealing our jurisdiction,” apparently meaning Republicans’ turf, for wanting to work with Democrats. Politico suggested that Alexander’s effort could come smack up against Hatch’s disapproval.

But not to be outdone and left off the legislative roster’s race card, on the same day of the block-grant announcement, Sen. Bernie Sanders (I-VT) introduced a single-payer plan that is already popular with many Democrats but has also exposed new divisions in the Liberal segment of the party.

Bottom Line:

The entire gamut of the GOP dispute tracks the party’s philosophical schism on Obamacare: Alexander argues the GOP has a responsibility to protect Americans from a collapsing healthcare market. Hatch, in a sentiment echoed by McConnell and Cornyn, is skeptical of repairing the Democrats’ admittedly faulty law without significant structural changes.

“He’s got a very broad jurisdiction but it isn’t as broad as he sometimes thinks,” the Utah Republican said of his colleague. “That doesn’t mean he can’t do legislation that’s outside of his jurisdiction–he can. But if he’s doing it, it ought to at least be something he runs by us.”

Hatch’s words reflect a legislator, akin to McConnell, committed to protocol and procedure. Alexander, on the other hand, argues the policy is more important than the jurisdiction. Amen to that. The winners (and losers) of this race could cross the finish line this week.