Some Republicans don't want to pay insurers for reducing out-of-pocket costs for low-income Obamacare customers unless they can get changes to the law.
Republicans are figuring out what to do about the cost-sharing reduction payments to insurers now that an effort to repeal Obamacare failed in the Senate. The Senate plans to hold hearings in September on how to stabilize the individual market, which houses Obamacare's exchanges, and want to have a solution by the end of that month.
Some Republicans say it is important to make the cost-sharing payments to ensure that the markets remain stable. Insurers are required under Obamacare to lower co-pays and deductibles for low-income enrollees and they are then reimbursed by the federal government.
But Republicans don't want to come away empty-handed.
"I would think if you could do something bipartisan where there is give and take, then there ought to be something given in return in terms of market reforms to lower premiums," said Sen. Ron Johnson, R-Wis.
Other Republicans were reticent to make the payments long term without any reforms.
"I don't think you can simply just say, well, we will send money into it right now without any reforms included," said Sen. Mike Rounds, R-S.D. "That doesn't fix the situation."
Sen. Lamar Alexander, R-Tenn., said Tuesday he told President Trump to make the payments through September to give Congress time to work on a solution. Alexander is chairman of the Senate Health, Education, Labor and Pensions Committee that plans to hold hearings on the individual market when Congress returns next month.
Sen. Susan Collins, R-Maine, said the payments need to continue and she derided some of her colleauges for calling them bailouts for insurance companies.
"When I hear them described as insurance company bailout that is just not an accurate description," she said. "The reason we have CSRs is to help low-income people who are only between 100-200 percent of the poverty rate afford their out of pocket costs."
Sen. Bill Cassidy, R-La., also called for funding the payments and said that families could be hurt.
Other senators add they need to get an idea of what Trump wants to do about the payments. The president has tweeted several times that he wants to let Obamacare implode.
Meanwhile, Democrats are hoping for a longer solution beyond just a short-term fix for 2018.
"I am concerned with Alexander talking about only a one-year fix," said Sen. Chris Murphy, D-Conn. "Solving the CSR problem for a year doesn't keep the insurance companies in."
Murphy said that if Democrats and Republicans get together to "forge a compromise then lets do it for more than one year."
While the payments have been made month-to-month, the president has refused to make a commitment for next year. Insurers have been forced to develop rates for 2018 with the cost-sharing reduction payments in flux. In some cases, it has led to higher rates in some states.
California's state-run Obamacare exchange announced Tuesday that premiums could rise an additional 12 percent on top of a planned 12 percent hike.
Further complicating the CSR debate is a battle over the legality of the payments.
The House sued the Obama administration in 2014, saying the payments to insurers were illegal because they weren't appropriated through Congress. A federal judge sided with the House last year but stayed her ruling until after the presidential election.
The Trump administration has not decided how it wants to proceed on the lawsuit. However, several administration officials such as Attorney General Jeff Sessions have called the payments unconstitutional.
Trump and the House Republican leadership could agree to drop the lawsuit and have Congress appropriate the payments, but no decision has been made.