Sen. Lamar Alexander tweeted that he would work with President Donald Trump on improving the bill to "make it even stronger" and ensure that it benefits consumers, not insurance companies. | John Shinkle/POLITICO Obamacare fix could end up in year-end package Republican sources say it's only a matter of time before Congress must find some way of addressing the reeling insurance markets.

A bipartisan deal to shore up Obamacare collapsed Wednesday after President Donald Trump and House Speaker Paul Ryan called the Senate proposal a bailout for insurance companies.

But GOP sources on both sides of the Capitol say this is not the end of the debate.


GOP lawmakers acknowledged they’ll eventually have to contend with shaky insurance markets and an estimated $1 billion hole Trump carved into the health care law last week when he eliminated remaining payments due this year. The money to fund a key insurance subsidy program could be resurrected as part of a year-end spending agreement.

Even if the deal struck by Sens. Lamar Alexander and Patty Murray goes nowhere, Republican sources say it's only a matter of time before Congress must find some way of addressing the reeling insurance markets — a vote the GOP sources know will infuriate lawmakers and their base. Put simply, the fight over Obamacare is nowhere near an end.

Alexander plans to introduce the bill Thursday along with a “significant” number of Republican and Democratic cosponsors. He predicted Wednesday that “by the end of the year chances are very good this agreement or something like it is law.”

POLITICO Pulse newsletter Get the latest on the health care fight, every weekday morning — in your inbox. Email Sign Up By signing up you agree to receive email newsletters or alerts from POLITICO. You can unsubscribe at any time. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

The most likely scenario is to push the matter off and fold a yet-to-be-determined solution into a year-end package they hope will include some GOP concessions as well as Democratic perks. Such a strategy, they argue, would be less painful than voting on a stand-alone bill that conservatives view as a "bailout" for insurance companies — and a vote to "prop up" a law they've tried to dismantle for years.

"We do know there's a problem with the high premiums and high deductibles because of the failures of Obamacare,” said Sen. John Cornyn (R-Texas). "And until we can come up with a long-term solution, I think stabilizing the marketplace and keeping premiums affordable is not a bad idea.”

Earlier in the day, Trump tweeted that he was "supportive of Lamar as a person & also of the process, but I can never support bailing out ins co’s who have made a fortune w/ O’care."

Ryan later suggested the House wouldn't take up the bill as written.

"The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare," Ryan spokesman Doug Andres said.

Alexander on Wednesday lobbied his GOP colleagues to get on board, arguing that funding the cost-sharing program doesn't amount to a bailout because it has to go directly to cover consumers’ out-of-pocket health costs. He also indicated that he’s open to changing the bill to address Trump’s concerns.

Ron Johnson (R-Wis.) is also working on a bill that would fund the cost-sharing payments and make concessions for conservatives.

The Alexander-Murray deal would provide two years of funding for Obamacare's cost-sharing subsidies. It would also give states more flexibility to oversee their insurance markets, expand the availability of low-cost health plans and restore some of the funding for enrollment outreach efforts the Trump administration slashed this summer.

But Alexander’s effort largely fell on deaf ears.

“I want to get to the long-term solution as quickly as possible. I’m just not a fan of bailing out insurance companies,” said Steve Daines (R-Mont.).

Trump’s opposition sealed the bill’s fate, at least in the short term. It would be all but impossible for Republicans lawmakers to support the deal — let alone bring it up for a vote in the House or Senate — without the president's endorsement. Republicans, still smarting from their failure to fulfill their years-long promise to repeal Obamacare, would have an extremely hard time voting for anything perceived as supporting the law without political cover from the president.

Before coming out against the proposal Wednesday, Trump spent Tuesday sending mixed signals on whether he would support the bipartisan effort. Early Tuesday, he suggested the White House was involved in crafting the legislation and praised the work by lawmakers. By the evening, he commended the work but trashed the idea of a bailout, echoing comments made by conservatives who oppose the deal.

Republicans were reluctant to weigh in on the deal after details of the bill were released Tuesday. But GOP sources, especially in the House, privately began dismissing the accord, saying the concessions wouldn’t be enough for most Republicans in the House.

Asked about a vote on the agreement Tuesday, Majority Leader Mitch McConnell said Republicans had not yet discussed a way forward. Ryan soon came out in a statement encouraging the Senate to pursue repeal — not an Obamacare "fix."

Some Republicans want a bigger concession from Democrats in exchange for continuing the payments. In an interview with POLITICO just hours after Trump ended the subsidies last week, Office of Management and Budget Director Mick Mulvaney said the White House would never back a stand -alone Alexander-Murray-type deal but could accept the measure if they got a border wall or something else for Trump.

White House legislative liaison Marc Short and GOP sources echoed that sentiment, suggesting that Republicans might instead secure a repeal of the individual and employer mandates under Obamacare .

Democrats are highly unlikely to back any kind of mandate repeal because they would view that as undermining the law. Murray told POLITICO that she views the bill's current language as final. "We negotiated," she said.

The Obamacare payments are estimated at about $7 billion this year and help insurers cover out-of-pocket costs for low-income customers. Insurance commissioners say about $6 billion of the money had been released before Trump's cutoff. A federal court last year ruled that the subsidies were illegally appropriated, but the Obama and Trump administrations had continued to pay them out while the litigation is under appeal. Many insurers, fearing the payments would be cut off, raised rates for 2018 health plans higher than they otherwise would have.

Minority Leader Chuck Schumer on Wednesday blasted Trump for flip-flopping. He said Trump probably did not know what was in the Obamacare deal and said his only hope was that Trump would quickly reverse course to support it.

Adam Cancryn contributed to this report.

