As open enrollment under the Affordable Care Act begins this week, Republican lawmakers are striking a difficult balance between advocating repeal of the law and ensuring that their constituents get insurance coverage.
“Well, that’s a catch-22 deal,” Sen. Richard Shelby (R-AL) acknowledged to The Daily Beast, joking that he thought Obamacare “had gone away already.”
Shelby added that he “wouldn’t encourage anybody to do anything with Obamacare other than repeal it.” In doing so, he reflected his party’s persistent frustration at the failure thus far to make good on a seven-year-long campaign promise to get rid of the law. But it’s not clear if the senator is speaking for the majority of his GOP colleagues in discouraging Americans from buying insurance.
Republican lawmakers are largely agnostic about whether their constituents should seek coverage during the open enrollment period, which began on Wednesday.
“We want individuals to have access to health care. That doesn’t change. The problem that we have is that so many individuals can no longer afford the health care that’s out there,” Sen. James Lankford (R-OK) told The Daily Beast, saying it would not be “incongruent” to encourage Americans to sign up for Obamacare while also advocating for its repeal.
“I don’t know that we’re putting out any word telling people to be able to sign up one way or the other,” Lankford added. “We encourage people to always get health insurance for their family. But we’re not doing doing any special emphasis during that time period.”
2017 is the fourth year in which the Obamacare exchanges have been operational. It is also expected to be the worst year for the exchanges. The continued attacks on the law by Republican lawmakers is part of the reason, Democrats have argued. Chiefly among them is the Trump administration’s attempts to undermine the law’s functionality.
The administration has dramatically shortened the window for enrollment and has scaled back advertising campaigns designed to encourage people to sign up. The Department of Health and Human Services has cut state funds aimed at helping people enroll in Obamacare and slashed advertising budgets—using money meant to promote the law on a campaign to undermine public confidence in it. The result, experts warn, is that fewer people will buy insurance.
Fearful that these actions could have an adverse effect on the markets, some GOP lawmakers have not shied away from encouraging people buy insurance coverage.
“I am encouraging Alaskans to recognize that this is open enrollment. This is their time,” Sen. Lisa Murkowski (R-AK), who has consistently opposed Senate Republicans’ repeal-and-replace plans, told The Daily Beast. “I think there’s been a lot of mixed messages. Some people say, ‘woah, I didn’t even know [Obamacare] was still in place.’ So I think it is important to remind them. … I don’t think you want people to be surprised. So education and awareness is in order.”
When reminded of her fellow Republican senators’ reluctance to encourage enrollment, Murkowski advocated working with the current system, however undesirable it might be.
“This is what we have in front of us today. I’ve been saying access is important. So don’t miss the opportunity for access,” she added.
Many GOP lawmakers have acknowledged that even if they had the votes to repeal Obamacare immediately, there would need to be a grace period whereby the existing system would be left in place before the new law is implemented. To that effect, at least a dozen Republicans and the same number of Democrats have co-sponsored legislation put forward by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) that would extend Obamacare subsidies known as cost-sharing reduction (CSR) payments for two years, and would give individual states more flexibility in enforcing insurance regulations.
Republicans have argued since Obamacare’s inception that the 2010 law would cause premiums to skyrocket and insurers to pull out of the marketplace. The nonpartisan Congressional Budget Office has warned that both would happen if Congress does not take action to restore the CSR payments that President Trump axed last month.
The Alexander-Murray plan would likely clear the 60-vote threshold in the Senate. But the House is tough territory for the legislation’s advocates, where conservative lawmakers have threatened to kill it altogether. Alexander and Sen. Mike Rounds (R-S.D.), who has been instrumental in the effort, have both said that the ball is now in Trump’s court.
“We’ve done our part here,” Alexander said bluntly.
Trump has changed his position on the issue at various points on CSR payments and has not yet committed himself to supporting it. Senate Majority Leader Mitch McConnell has said he would not put the legislation to a floor vote until it has the president’s support.
In the meantime, Rounds say Obamacare is “the only game in town” for people who want to buy health insurance, and Congress has an obligation to “lessen the blow” on consumers until it is eventually repealed and replaced. For Rounds, that means passing Alexander-Murray as a way to stabilize the existing insurance exchanges.
“For those individuals that need health care, they don’t have another alternative,” Rounds told The Daily Beast. “And we want to do everything we can to help them get through the tough times so we can actually get competitive markets again. … As a last resort, they may not have a choice except to accept it. But for me, it would be a last resort.”