Congress at crossroads after another GOP health care failure

Congress is at a crossroads after Republicans' stinging failure to repeal Barack Obama's health care law. But what's next — more partisan conflict, or a pragmatic shift toward cooperation?

Unless Republicans and Democrats in Congress can work together — and bring along an often unpredictable President Trump — political conflict over health care may spread. Bipartisan talks on legislation to stabilize the health law's shaky insurance markets are on again, but time is short and there's no guarantee of success.

Adding to concerns: Congress has yet to renew funding for programs that traditionally enjoy broad support, such as children's health insurance and community health centers, despite approaching deadlines.

Feelings were raw Tuesday after Senate GOP leaders announced they would not take their latest "repeal and replace" bill to the floor for lack of support. But some lawmakers said it's still possible to bridge the partisan gap on a limited set of priority issues.

Sen. Lamar Alexander, R-Tenn., said he would resume efforts to reach a bipartisan deal with Democratic Sen. Patty Murray of Washington to stabilize markets for individual insurance policies that 18 million people rely on. More than half of those consumers are covered under the health law.

Alexander is chairman of the Health, Education, Labor and Pensions committee, and Murray is his Democratic counterpart. He runs the risk of being accused by some fellow Republicans of trying to "bail out Obamacare."

Murray is under pressure from fellow Democrats not to make concessions to Alexander, who is seeking changes that would ease the path for states to get waivers from some of the law's requirements, potentially leading to plans with lower premiums.

"I'm still concerned about the next two years, and Congress has an opportunity to slow down premium increases in 2018, begin to lower them in 2019, and do our best to make sure there are no counties where people have zero options to buy health insurance," Alexander said in a statement.

Sen. Ron Wyden, D-Ore., who has worked with Republicans on a range of health care issues, said cooperation is the only way to avoid creating needless problems for constituents.

"You recognize the opportunities that are in front of you," said Wyden, ranking Democrat on the Finance Committee, which oversees health care funding. "My hope is we can come together."

Wyden's list includes renewing the Children's Health Insurance Program for 9 million kids, whose funding expires this week, as well as short-term action to stabilize the Affordable Care Act's insurance markets, by guaranteeing subsidies for copays and deductibles. Experts say that could cut expected double-digit premium increases in many states by about half.

The missing ingredient seems to be leadership, say outside observers.

Neither Trump, nor House Speaker Paul Ryan, nor Senate Majority Leader Mitch Connell has given clear approval for a bipartisan approach. Some Republican and Democratic governors have called for a health care reset that would involve both parties working together on a limited agenda, but their suggestion hasn't been embraced in Washington.

"The question is whether you can you forge a coalition that doesn't include either the hard right or the hard left," said GOP health economist Gail Wilensky. "I have not been able to answer who would provide the leadership for such an effort. Neither the leadership in the House or the Senate has embraced the notion of trying to forge a bipartisan coalition, and it is very hard to move legislation without that."

Rep. Richard Neal, D-Mass., said Tuesday that Trump at a meeting with lawmakers raised the possibility of seeking a deal with Democrats. There's no hint what that might entail.

If anything, Democrats have been moving to the left after Vermont Sen. Bernie Sanders relaunched his "Medicare for all" plan recently. Under Sanders' plan, government would pay for medical services, replacing employers and insurers. Some liberal activists argue that support for "single-payer" should be a qualifying test for Democratic candidates in 2018 and beyond.

Other Democrats say single-payer would lead to political defeat, because of the massive tax increases required.

"It's not going to happen," said former congressman Henry Waxman, one of the main authors of the Obama law. "You can talk about it, and plant a flag, and say that's where you'd like to go, but in the meantime people need their insurance coverage."

Wednesday is the deadline for insurers to sign contracts to offer policies for 2018 on the health law's markets. Sign-up season starts Nov. 1. About half the 18 million Americans with individual policies get no subsidies under the health law. Without congressional action some are facing premiums that rival a mortgage payment.

Saturday is the deadline for Congress to act on children's health insurance and community health center funding. Brief delays are not expected to cause disruptions, but a protracted holdup would.