“This has been just a really long process of my Republican friends coming to terms with reality,” Rep. Jim Himes, chairman of the 61-member New Democrats Coalition, told me yesterday. “I think the challenge now is can they sell something short of repeal – that is, improvement – to their voters.”

AD

When Himes became leader of the group of moderate Democrats late last year, he expressed eagerness to work across the aisle on issues like infrastructure and education, but said the plan for health care was to “sit back and watch” as Republicans rushed headlong down the Obamacare repeal tunnel.

AD

That tunnel appeared to run into a dead end last Friday, when the Senate failed by a single vote to pass a “skinny repeal” bill, demonstrating that even after shutting out Democrats the GOP still can't agree on health care.

So has the death of partisan efforts fertilized the ground for a garden of bipartisan cooperation? Seems doubtful to us, given how polarizing health care has been over the past seven years.

AD

But Himes sees opportunity nonetheless.

He has signed onto a set of proposals to stabilize and improve the marketplaces laid out this week by a 43-member bipartisan group called the Problem Solvers Coalition. The most prominent Republican member is Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce Committee (a key health-care panel). Tweets from a few Democratic members yesterday:

AD

Rep. Brad Schneider (D-Ill.):

Rep. Scott Peters (D-Calif.):

Their asks includes permanently funding extra Obamacare subsidies for cost-sharing discounts, repealing the ACA’s medical device tax, giving states greater flexibility to manage their marketplaces and creating a federal fund to help cover the costs of the sickest, most expensive patients.

“The path forward to fixing the health-care mess is seeking bipartisan, common-sense common-ground,” Upton said in a statement.

AD

Another prominent Republican moderate, Ohio Gov. John Kasich, tweeted his approval:

Himes acknowledges the group's proposals wouldn’t fix big, systemic problems with the U.S. health-care system. But their ideas do demonstrate there’s a universe where the two parties can reach some agreements, if small.

AD

“[The proposal] was to demonstrate to the world you can put Republicans and Democrats in a room and come out with a solution,” Himes told me.

He emphasizes there are some parts of the proposal he doesn’t like – including its repeal of taxes on medical devices. But that’s the point of bipartisan legislation, he says. Everyone will be unhappy with parts of it, but happy with other parts.

AD

“It makes everyone a little grumpy because it’s a compromise,” Himes said.

Yet Republicans face ongoing, heavy pressure from the White House to revisit their partisan repeal-and-replace effort, largely via a string of tweets from President Trump blasting them for failing to pass a bill and threatening to hold hostage extra Obamacare subsidies for insurers that could help stabilize the marketplaces. Rep. Charlie Dent (R-Pa.), a member of the Problem Solvers Coalition, shared his frustration with HuffPost's Jennifer Bendery:

And Republican leaders in the House and Senate haven’t given any hints they’d be willing to work alongside Democrats to improve the ACA. Senate GOP leaders signaled yesterday that they plan to move on from health-care to other legislative priorities, my colleague Sean Sullivan reports.

AD

AD

“We’ve had our vote, and we’re moving on to tax reform,” said Sen. John Thune (S.D.), one of Senate Majority Leader Mitch McConnell’s top lieutenants.

Sen. Roy Blunt (Mo.), another member of the Republican Senate leadership, put it this way: “I think it’s time to move on to something else. Come back to health care when we’ve had more time to get beyond the moment we’re in — see if we can’t put some wins on the board.”

McConnell did not address health care in his remarks opening Senate business on Monday afternoon. His top deputy, Sen. John Cornyn (Tex.), brushed back comments White House budget director Mick Mulvaney made on CNN on Sunday urging Republicans not to vote on anything else until voting on health care again.

AD

“I don’t think [Mulvaney’s] got much experience in the Senate, as I recall,” said Cornyn as he made his way into the Senate chamber. “And he’s got a big job. He ought to do that job and let us do our job.”

AD

Meanwhile, Democratic leaders are calling for bipartisan work on health-care. Senate Majority Leader Charles E. Schumer (D-N.Y.) said yesterday he's gotten responses from 10 of his Republican colleagues -- and said he's "all for" the concepts laid out in the Problem Solvers' proposal. House Minority Leader Nancy Pelosi (D-Calif.) hasn't endorsed the plan, but she did give it a nod yesterday.

“Congress has a responsibility to work together in a bipartisan fashion for the good of the American people,” Pelosi said in a statement. “The Republican leadership should finally move past repeal, follow the example of their members releasing some proposals with Democrats today, and come to the table for serious bipartisan conversations.”

AD

The New Democrats (Himes’s group) sent four similar requests to House Speaker Paul D. Ryan (R-Wis.) last week. The speaker should create a permanent federal reinsurance program and fund the cost-sharing subsidies, and advance policies helping more people get covered and have access to affordable plans, the caucus wrote.

AD

And even before last week’s meltdown, as Republicans struggled to move beyond intraparty bickering, a handful of moderate Senate Democrats also proposed legislation to improve the marketplaces.

Sens. Tim Kaine of Virginia and Thomas R. Carper of Delaware rolled out a bill creating a permanent reinsurance program to help insurers lower premiums for the sickest and most expensive patients, who might otherwise struggle to pay for their plans.

AD

Before insurer Centene announced it would sell plans in Missouri’s so-called “bare” counties next year (where no marketplace insurers existed), the state’s Democratic Sen. Claire McCaskill had proposed legislation allowing people with no plan options to buy on D.C.’s marketplace instead.

Other Democrats are calling for bipartisan fixes, too:

From Sen. Maria Cantwell (D-Wash.):

Sen. Chris Murphy (D-Conn.):

Health-care wonks encouraged bipartisan cooperation too. From Brookings Institution's Loren Adler:

Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services under Obama:

AHH, OOF and OUCH

AHH: Twenty counties in Ohio were at risk of no insurers selling plans on the marketplaces in 2018 -- but no longer. The state's insurance director announced yesterday that five companies have stepped up to sell plans in the trouble areas, leaving only one Ohio county currently without an insurer, writes The Post's Carolyn Johnson. The void was created in June when the state's major insurer, Anthem, announced that it would pull out of Ohio.

AD

“Ohio has long had a strong insurance system, and once again our insurers stepped up at an important time for thousands of Ohioans, taking unprecedented action to provide access to health insurance for Ohioans who otherwise were without options,” insurance director Jillian Froment said in a statement.

"A single Ohio county, Paulding County, still has no insurer expected to offer plans on the exchange," Carolyn reports. "Froment said that regulators are searching for coverage options for that county. State insurance commissioners have been working with companies to plug potential gaps over the past few months."

Other states with "bare" counties have seen insurers enter as well. "After quite a bit of suspense over whether Iowa would have any insurers offering marketplace plans next year, the Midwestern insurer Medica stepped in to offer plans statewide," Carolyn writes. "Missouri, once at risk of seeing multiple counties lose their insurance options, was able to work with the insurer Centene to fill in bare counties."

“State insurance regulators have a fair amount of latitude to get plans to participate,” said Dan Mendelson, president of Avalere Health, a consulting firm. “There is a back-and-forth that provides some level of insulation from the craziness of the federal legislative process and the federal administrative process. The states really have an interest in providing continuity.”

OOF: Democrats will not withhold financial support for candidates who oppose abortion rights, the chairman of the party’s campaign arm in the House said yesterday per The Hill. Rep. Ben Ray Luján (D-N.M.) said there will be no litmus tests for candidates as Democrats seek to regain the House majority in 2018 -- a position that risks alienating liberals, as well as groups dedicated to promoting access to abortion rights that represent the core of the party’s base.

AD

“As we look at candidates across the country, you need to make sure you have candidates that fit the district, that can win in these districts across America," Lujan said. "To pick up 24 [seats] and get to 218, that is the job. We’ll need a broad coalition to get that done. We are going to need all of that, we have to be a big family in order to win the House back.”

House Minority Leader Nancy Pelosi (D-Calif.) and Senate Minority Leader Charles E. Schumer (D-N.Y.) have both said there’s room within their party for people with different opinions on abortion. Abortion rights group NARAL Pro-Choice America wasn't pleased to hear Lujan's statement, however. “Throwing weight behind anti-choice candidates is bad politics that will lead to worse policy,” said spokeswoman Mitchell Stille. “The idea that jettisoning this issue wins elections for Democrats is folly contradicted by all available data.”

OUCH: Rep. Orrin G. Hatch (R-Utah), chairman of the powerful Senate Finance Committee, said yesterday that senators for now are too divided to keep working on health-care overhaul legislation and that he and other senior Republicans will take that message to the White House, Reuters reported.

"There's just too much animosity and we're too divided on health care," Hatch said in the interview with Reuters. Hatch said he thinks Congress will have to fund cost-sharing subsidies that help make Obamacare plans more affordable for the lowest-income enrollees, although he'd prefer not to.

TRUMP TEMPERATURE

--Even as nearly every GOP leader in Congress says it's time to set health-care aside and move on to a tax rewrite, Trump isn't giving in. He's been tweeting daily threats bashing the GOP for refusing to revisit the issue, warning Republicans that he'll refuse to fund the cost-sharing subsidies (a move which would seriously undermine the marketplaces). Monday morning, he doubled down on a threat to remove the employer contribution to health- insurance plans for members of Congress and their staff:

--Trump is apparently considering taking executive action in the vacuum left by the Senate's failure to pass its "skinny repeal" bill. Yesterday, Sen. Rand Paul (R-Ky.) said he offered the idea to the president during a phone call, where he suggested Trump had the authority to create associations that would allow organizations to offer group health-insurance plans and thereby negotiate for lower rates.

"Well I just got off the phone with the president, and I think he and I both want to get something done,” the Kentucky Republican told reporters. “What I'm talking to him about is that I think through executive action, I think he can legalize the health associations that I've been talking about.”

--Also yesterday, the White House hosted a meeting with Sen. Bill Cassidy (R-La.) and several governors to discuss how to restart action. “We had a productive meeting. All involved want a path forward,” said Cassidy in a statement after the meeting. Cassidy has teamed up with Sens. Lindsey O. Graham (R-S.C.) and Dean Heller (R-Nev.) on their own health-care proposal.

--Trump's opioid commission is asking something of him, The Post's Christopher Ingraham reports. Yesterday, the President's Commission on Combating Drug Addiction and the Opioid Crisis issued a preliminary report stating that its “first and most urgent recommendation” is for the president to “declare a national emergency" due to opioid abuse.

“With approximately 142 Americans dying every day,” the report notes, “America is enduring a death toll equal to September 11th every three weeks.”

The commission, led by New Jersey Gov. Chris Christie (R), says that the goals of such a declaration would be to force Congress to provide more funding for prevention and spread public awareness about the issue. Trump established the opioid commission in March, with a mandate to “study ways to combat and treat the scourge of drug abuse, addiction, and the opioid crisis.” But the report didn't include some harsher measure the president has called for in the past.

"Notably absent from the report are a number of tough-on-crime measures that Trump and Attorney General Jeff Sessions have repeatedly offered up as solutions to the opioid crisis, including building a wall on the Mexican border, expanding the use of mandatory minimum sentencing for drug crimes, and seizing more cash and property from individuals suspected of drug crimes," Christopher reports.

Other good reads from The Post and beyond:

HEALTH ON THE HILL

MEDICAL MISSIVES

SECOND OPINION

DAYBOOK

Coming Up

Brookings Institution is holding an event on "Procedure and politics in the 115th Congress" on Wednesday.

The Senate Finance Committee considers Matthew Bassett, a nominee to be the Assistant Secretary of Health and Human Services on Thursday.

SUGAR RUSH

The Post's Ashley Parker, Carol D. Leonnig, Philip Rucker and Tom Hamburger report President Trump intervened to write Donald Trump Jr.'s statement on meeting with a Russian lawyer:

Watch a dramatic reenactment of Anthony Scaramucci’s phone call to The New Yorker reporter Ryan Lizza: