The Senate’s GOP leaders probably thought they had a winning formula to force Alaska Sen. Lisa Murkowski into finally voting to dismantle the Affordable Care Act.
The current Senate tax proposal includes both a repeal of the ACA’s individual mandate to buy insurance and provisions to begin opening the Arctic National Wildlife Refuge to drilling. It was shaping up to be a difficult decision for the moderate senator. She would have to choose between the least-popular, but critical part of an insurance system that she’s defended and one of the biggest wins an Alaska politician can bring home (which is setting aside all the incredibly unpopular tax provisions of the tax bill).
It turns out that it’s not that easy to paint Murkowski into a corner.
Murkowski proved her political skill in making a bold counter offer, which she suggested in interviews late Thursday. She’ll vote for the tax bill, including the repeal of the individual mandate to buy insurance that the GOP added this week, once the Senate approves the bipartisan fix for Obamacare known as Alexander-Murray.
“I think that there is a path and I think the path is a reasonable path,” Murkowski said in an interview reported by Roll Call. “If the Congress is going to move forward with repeal of the individual mandate, we absolutely must have the Alexander-Murray piece that is passed into law.”
The Alexander-Murray legislation would guarantee cost sharing reduction (CSR) subsidies that President Donald Trump has already cut off and offer states greater flexibility to adopt tailored insurance market fixes like Alaska’s reinsurance program. The legislation has been popular with moderates Republicans and Democrats, but has been continually sidelined by Republican efforts for an all-out repeal of Obamacare.
The provisions of Alexander-Murray could, taken together, more than offset the hikes that repealing the individual mandate would have on premiums. The repeal of the individual mandate could spike premiums by as much as 10 percent because fewer healthy people would have to buy insurance, according to Congressional Budget Office estimates. Alaska’s reinsurance program, which Alexander-Murray would make easy for other states to adopt, saved Alaskans more than 22 percent on premiums and Trump’s decision to end cost-sharing subsidies is expected to spike insurance rates by 20 percent.
Murkowski’s proposal is a reasonable compromise between the politically driven effort to undo the Affordable Care Act and efforts to fix the flaws of the Affordable Care Act. It also helps Republicans, to a limited extent, with the balancing a tax bill that favors big corporations and the wealthy at an increasingly obvious cost to the poor and middle-class, a reality that Murkowski is clearly aware of.
“There is a path forward. It just means that some who have said some nasty things about CSRs are maybe just going to have to acknowledge that, well, this might be the way that you thread this needle,” she said. “If that tax cut is offset by higher premiums, you haven’t delivered benefit.”