While enthusiasm for pursing another vote on ACA repeal and replace in the Senate appears to have dimmed, hopes for repeal have not yet been extinguished. At the same time, a bipartisan group of Senators is working on a narrow insurance stabilization approach.

Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) have continued working on their repeal and replace proposal and may introduce the latest version of their legislation as early as today. The Graham-Cassidy proposal would convert ACA insurance subsidies and Medicaid funding to a block grant program, for States to use to develop their own approaches to health care coverage. Graham and Cassidy aim to have the Congressional Budget Office score the bill quickly so the legislation would be ready for consideration before the end of September, when the Senate Parliamentarian has ruled that reconciliation instructions, which permit a simple majority of 51 votes to pass legislation in the Senate, expire.

At the same time, Senate Health, Education, Labor and Pensions (HELP) Chairman Lamar Alexander (R-TN) and ranking member Patty Murray (D-WA) are working to pass a narrow, bipartisan insurance stabilization bill by the end of the month, when final 2018 plan rates must be filed with CMS. Last week, the HELP Committee held two hearings on proposals to stabilize the ACA marketplaces, to be followed by two hearings this week:

• September 12: “Stabilizing Premiums and Helping Individuals in the Individual Insurance Market for 2018: State Flexibility”
• September 14: “Stabilizing Premiums and Helping Individuals in the Individual Insurance Market for 2018: Health Care Stakeholders”

Alexander described the HELP Committee approach and outlined the components of the small, targeted legislation, stating:  “To get a result, Democrats will have to agree to something—more flexibility for States—that some are reluctant to support. And Republicans will have to agree to something—additional funding through the Affordable Care Act—that some are reluctant to support.” Chairman Alexander recognized that the HELP Committee does not have jurisdiction over large portions of the ACA, such as taxes, Medicare, and Medicaid—which are under the jurisdiction of the Senate Finance Committee—but noted that he was working closely with his colleagues, nine of whom served on both the HELP and Finance Committees.

Last Friday, Senate Finance Committee Chairman Orrin Hatch (R-UT), authored an op-ed in The Washington Post urging that the Senate avoid an approach to “shore up the bad policies in place with another slate of bad policies” and instead “the Senate should work to provide relief for Americans that can only come about with significant, long-term reforms to the health-care system.” The Senate Finance Committee is scheduled to hold a hearing this week on health care coverage issues:

• September 12 “Health Care: Issues Impacting Cost and Coverage”

If a compromise can be reached on an insurance market stabilization bill, it would likely be considered as part of a larger package, as opposed to a stand-alone bill. While a number of must-pass legislative items, such as emergency hurricane relief, a continuing resolution funding the government, and a debt limit suspension were enacted last week, other potential legislative vehicles for health care reform are additional disaster relief funding or an extension of the Children’s Health Insurance Program funding, which expires September 30.