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 Donald Trump, political conflict over health care may spread. Bipartisan talks on legislation to stabilize shaky insurance markets are on again, but time is short and there's no guarantee of success.
Congress also 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. 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 Sen. Patty Murray, D-Wash., 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 Senate Health, Education, Labor and Pensions Committee; Murray is the top Democratic on the committee. Alexander 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 make it easier 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.
Neither Trump, nor House Speaker Paul Ryan nor Senate Majority Leader Mitch Connell has given clear approval for a bipartisan approach, though Trump said Wednesday that he will meet with Democrats and "see if I can get a health plan that is even better."
The president also said he's looking at taking executive action to make health care changes, including a "major executive order" that would allow people to buy insurance across state lines.
Trump insisted Republicans "have the votes" to pass legislation to repeal and replace former President Barack Obama's signature health care law, but it may not come until next year.
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, the top Democrat on the Senate 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 copayments 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.
Some 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 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 Sen. Bernie Sanders, I-Vt., 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 Rep. Henry Waxman, D-Calif., 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.