What is next for ACA repeal may be clearer later this week when and if Congressional leaders decide whether to include in the 2018 budget resolution an instruction to repeal the ACA.  Such a provision would muddy the fast track for tax cuts but would keep alive another shot at the Graham-Cassidy-Johnson-Heller block grant/Medicaid per capita cap proposal.

By week’s end there were signs that Senator Lamar Alexander (R-TN) and Senator Patty Murray (D-WA) will be reviving their efforts to find a temporary bipartisan fix to the current ACA law.

The HELP Committee held four hearings in September.  The hearings focused on the need to fund the CSRs, Cost-Sharing Reductions, greater flexibility in the current waiver process and as Senator Lamar Alexander (R-TN) suggested, expand the availability of “copper” or catastrophic plans.  There are likely some bipartisan ideas such as placing a time limit on HHS in their approval process.  There also seemed to be a consensus on allowing “copy-cat” waivers that would allow one state to copy another state’s proposal and adjusting the current cost neutrality requirement to apply across both Medicaid and the ACA.

Alexander was attempting to announce a deal just when Senator Lindsey Graham pushed his way into the health care debate and pushed the Senate to re-open the ACA repeal effort.  That resulted in Alexander calling off all his efforts.  If there is an Alexander-Murray deal, perhaps by the end of this week, the bigger question will be can it get 60 votes in the Senate and then there is the House challenge.

It is uncertain where the President is on such an effort although he said he might talk to Democrats next year on a health care deal that would be “bigger and better.”