Though we were optimistic about the chances of swift, bipartisan action on CHIP last week, that optimism has waned as the partisan rhetoric around repealing and replacing the Affordable Care Act has heated up again. The simple fact of the matter is that you cannot have movement on these two initiatives at once. Unfortunately, the bipartisan work to stabilize the individual insurance market (spearheaded by Senators Alexander and Murray) faces a similar fate – it can’t move forward if Graham-Cassidy does.
Senators Hatch and Wyden continue to show their commitment to extending CHIP funding. Just today they released more details on the agreement announced last week, introducing the “Keeping Insurance Dependable and Secure (KIDS) Act” (S. 1827). Senators Alexander and Murray are doing the same for those with private insurance – actively working to announce a bipartisan deal to stabilize the individual insurance market.
All of these proposals are vying for time on the Senate floor before September 30. Of course, readers of SayAhhh! already know that a CHIP funding extension is needed by September 30. Graham-Cassidy is on the same timeline because the ability to bypass the Senate’s usual rules requiring a super majority to pass legislation expires on September 30 too. Insurance market stabilization is also needed very soon as the deadline to finalize rates for 2018 is imminent.
There are only 12 days left in September, and there are even fewer legislative days. The Senate will have a short week this week and next to observe Rosh Hashanah and Yom Kippur, limiting the total number of legislative days between now and the end of September to six at the most. I am often asked to predict how the Senate will move forward because I spent a number of years working there. I usually respond that my crystal ball is foggy – it’s very hard to predict the actions of politicians because things are constantly evolving. But I can safely say that it is highly unlikely if not impossible to move forward on two completely different paths and come to any productive resolution in the span of six legislative days.
Crafting complicated legislation takes time. The process typically begins with informal meetings to gather information from stakeholders and take stock of member priorities. From there, the committees of jurisdiction have public hearings to vet policy ideas and learn about their implications. The Senate Finance and HELP Committees have demonstrated this process in their work on CHIP and market stabilization. After a hearing (or several in the case of complicated legislation), the committee of jurisdiction would typically have a markup. At a markup, the Chairman (and Ranking Member in the case of bipartisan legislation) would share a proposal and members of the committee would review it and offer amendments. The final product would then move from the committee to the full Senate for consideration. All along the way, the Congressional Budget Office (CBO) would provide analyses of the legislation, including estimates on how much it would cost and, in the case of health coverage legislation, how many people would gain or lose coverage.
But process constraints are not the only factor in my assessment that Graham-Cassidy jeopardizes progress on CHIP and market stabilization. It’s also not possible for the professional staff working on these issues to negotiate in good faith when the paths forward diverge so sharply. For example, it would not be possible to have a good faith negotiation on extending CHIP funding (which covers 9 million children) while there is a live debate on gutting Medicaid (which covers 37 million children). This is not simply a matter of Congress learning to multi-task – you simply cannot work toward two totally different goals simultaneously. Members of Congress, their staff, states, stakeholders and the media, all need to have sufficient time to focus on the details and analyze the impact of each proposal.
So Congress is facing a choice, one that I would argue is easy. Should you return to the reckless, partisan path of repealing the ACA, risking the health coverage of millions of Americans, or should you forge forward on a bipartisan, constructive approach to secure coverage for the roughly 9 million children covered by CHIP and the over 1 million children insured through the Marketplace? Should you rush through a repeal bill that does not have (and will not have) a full CBO analysis outlining the fiscal and coverage implications or go down the bipartisan path that builds on work done by the committees of jurisdiction and supported by nonpartisan experts? I know what I would do.