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Senate Health Care Deal in Doubt       10/18 05:45

   A bipartisan Senate deal to curb the growth of health insurance premiums is 
on shaky ground. President Donald Trump has reversed course and opposes the 
agreement and top congressional Republicans and conservatives are giving it a 
frosty reception. 

   WASHINGTON (AP) -- A bipartisan Senate deal to curb the growth of health 
insurance premiums is reeling after President Donald Trump reversed course and 
opposed the agreement and top congressional Republicans and conservatives gave 
it a frosty reception.

   Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., announced their 
accord Tuesday after weeks of negotiations and five days after Trump said he 
was halting federal subsidies to insurers. Under the lawmakers' agreement, the 
payments would continue for two years while states were given more leeway to 
let insurers sidestep some coverage requirements imposed by President Barack 
Obama's health care law.

   In remarks Tuesday in the Rose Garden, Trump called the deal "a very good 
solution" that would calm insurance markets, giving him time to pursue his goal 
of scrapping Obama's 2010 Affordable Care Act, the target of Republican 
derision since it was signed into law.

   Although top Democrats and some Republicans praised the Alexander-Murray 
compromise agreement, Trump backed off after a day of criticism from many in 
the GOP.

   In an evening speech at the conservative Heritage Foundation, he said that 
"while I commend" the work by the two senators, "I continue to believe Congress 
must find a solution to the Obamacare mess instead of providing bailouts to 
insurance companies."

   A White House official said Trump's statement was aimed at conveying 
opposition to the Alexander-Murray plan. The official spoke on condition of 
anonymity to discuss internal deliberations.

   The subsidies --- called cost-sharing reductions --- go to insurers for 
reducing out-of-pocket costs for lower-income people. Since Obama's law 
requires insurers to make those cost reductions, insurers and others have 
warned that halting the subsidies would force premiums higher and prompt some 
carriers to abandon unprofitable markets.

   "This agreement avoids chaos," Alexander said when he announced the deal. "I 
don't know a Republican or Democrat who benefits from chaos."

   Alexander said the president had encouraged his efforts in two phone calls 
in recent days. But Trump has also repeatedly called the subsidies bailouts of 
insurers, who he's pointedly said have contributed little to his campaigns.

   Just minutes before Alexander announced the deal, White House legislative 
director Marc Short told reporters that "a starting point" in exchange for 
restoring the cost-sharing payments "is eliminating the individual mandate and 
employer mandate." Those are the central pillars of "Obamacare," and Democrats 
solidly oppose eliminating them.

   Senate Majority Leader Mitch McConnell was noncommittal about the agreement, 
telling reporters, "We haven't had a chance to think about the way forward 
yet." Aides to House Speaker Paul Ryan, R-Wis., did not provide a statement 
from him.

   Both McConnell and Ryan have been eager to turn national attention away from 
the GOP push to scuttle Obama's law, which crashed in the Senate twice, and 
toward an effort to cut taxes.

   Reaction from other Republicans toward the Senate agreement was mixed. For 
many conservatives it's practically unthinkable to sign off on federal payments 
that would arguably prop up a law they've been vowing for seven years to 

   Rep. Mark Walker of North Carolina, chairman of the conservative Republican 
Study Committee in the House, quickly denounced the deal over Twitter: "The GOP 
should focus on repealing & replacing Obamacare, not trying to save it. This 
bailout is unacceptable."

   Freedom Caucus Chairman Rep. Mark Meadows, who's been at work on a proposal 
of his own, was slightly more positive, calling the Alexander-Murray bill "a 
good start" but saying much more work needed to be done.

   Alexander said he and allies including Sen. Mike Rounds, R-S.D., would spend 
the next several days trying to build up support with the goal of formally 
introducing legislation later this week. If the legislation does pass, it would 
almost certainly be as part of a larger package including must-pass spending or 
disaster relief bills and that might not be until the end of the year.

   Murray lauded the effort, saying, "When Republicans and Democrats take the 
time ... we can truly get things done" for the American people.

   The Alexander-Murray deal includes provisions allowing states faster and 
easier access to waivers that would allow them to shape their own marketplace 
plans under "Obamacare."

   It would provide for a new low-cost catastrophic coverage insurance option 
for all consumers. It would also restore $106 million for outreach and 
enrollment programs aimed at prodding people to buy policies --- efforts that 
Trump has slashed.

   A federal judge ruled in a 2014 lawsuit brought by House Republicans that 
Congress never legally authorized spending money for the insurers' subsidies. 
Obama and Trump, initially, continued making the payments, though Trump 
declared last week he would pull the plug.

   The payments, which cost around $7 billion this year, lower expenses like 
co-payments and deductibles for more than 6 million people. But discontinuing 
them would actually cost the government more money under Obamacare's 
complicated structure, because some people facing higher premiums would end up 
getting bigger tax subsidies to help pay for them. 


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