Last Tuesday, Senator Lamar Alexander (R-TN) and Senator Patty Murray (D-WA) announced they had reached a comprise package on modest changes to the ACA.  The deal, worked on for several weeks, would extend for two years the Cost Sharing Reductions (CRS) subsidies the President has cut off, allow a more streamlined state waiver process, and expand the options for lower cost stripped down policies (copper plans).

The President changed his position several times starting right after the deal was announced going from support to opposition to possible support.  At the same time some prominent Senators including Senator McCain (R-AZ), Murkowski (R-AS), Senator Collins (R-ME) and Senator Rounds (R-SD) were among the 11 Republicans that joined Senator Alexander in supporting the deal.

While that was positive every other signal of possible passage was negative.  Speaker Paul Ryan (R-WS) sounded his opposition along with Senator Orrin Hatch (R-UT).  Hatch, as Chair of the Senate Finance Committee, has some jurisdiction over the bill.  That raised questions as to the process.  Would there be Committee action before the bill moved through the Senate, if it moves through the Senate?  Senate Majority Leader McConnell (R-KY) suggested over the weekend that putting a bill on the floor would require the President to give his approval.  At the same time Minority Leader Schumer (D-NY) said there were 60 votes in the Senate to pass the bill.  If the Senate act, there is the challenge of getting such a bill through the House.  Some have suggested that the best and perhaps only route is to attach it to some legislative must-pass vehicle in December.  That December “bill” of must pass actions and reauthorizations appear to grow each day.  In the meantime, HHS is adding to the restrictions to the open enrollment process set to start in November.