If a bill that would repeal portions of Obamacare fails in a planned Senate vote early next week, the effort would not be the end of the road for lawmakers, who would be left with the responsibility of rebooting Obamacare's exchanges so they aren't deeply damaged during an election year.
After Republicans couldn't reach a consensus on a bill that would have repealed parts of Obamacare and replaced it with other provisions, they proposed dusting off a bill they had passed in 2015 and voting on it again now that they had a president who would sign it into law rather than veto it. Early Tuesday, however, enough Republicans opposed beginning debate on the bill to stop the bill from advancing, but Senate leaders said they still planned to move forward on a vote on whether to debate the legislation.
If the bill fails as expected, lawmakers could return to debating the repeal and replace bill or work with Democrats to fix the Obamacare exchanges.
Senate Majority Leader Mitch McConnell previously warned Republicans that if they failed to reach an agreement they would have to work with Democrats to fix the healthcare law, and he reiterated that position Tuesday.
"You'll have to look at our committee chairmen and our ranking members," McConnell said, referring to the GOP and Democratic leaders of each committee. "My suspicion is there will be hearings about the crisis that we have, and we'll have to see what the way forward is."
Several senators have expressed an interest in reaching across the aisle.
Sen. John McCain, R-Ariz., said shortly after the partial repeal bill's demise Monday that he wanted to return to "regular order" to craft a new bill. That includes holding hearings and reaching out to Democrats.
Sen. Susan Collins, R-Maine, called for the Senate Health, Education, Labor, and Pensions Committee to hold hearings to create a bipartisan bill. She has consistently said that she believes the parties should work together on fixing Obamacare.
On the House side, healthcare dominated a periodic meeting held Tuesday between the Republican centrist Tuesday Group and the New Democrat Coalition, The Hill reported.
One of the first orders of business is likely to be dealing with the Obamacare exchanges, which offer tax-subsidized plans to people who do not get coverage through work or through the government. The exchanges are struggling to operate well because not enough young, healthy people have enrolled in the plans they offer to balance out the costs of sicker enrollees.
Insurers have left exchanges in different states, and residents of 38 counties are facing the prospect of having no insurer to purchase coverage from next year, according to the Kaiser Family Foundation. Other insurers are requesting significant rate increases on premiums next year, citing uncertainty about the subsidies and lack of clarity about what will happen to Obamacare.
Senate HELP Committee Chairman Lamar Alexander, R-Tenn., announced that he will be holding hearings in the next few weeks on stabilizing the Obamacare markets.
Alexander has been a staunch advocate of a short-term stabilization measure.
"However the votes come out on the healthcare bill, the Senate health committee has a responsibility during the next few weeks to hold hearings to continue exploring how to stabilize the individual market," he said.
Some of the approaches likely to be considered would involve providing additional federal money to insurers so they can reduce the cost of premiums, such as in the form of reinsurance, which provides funding to pay for more costly enrollees and could reduce premiums for those who do not qualify for subsidies. The Department of Health and Human Services recently approved a waiver in Alaska to allow for that, and a reinsurance program implemented by the state had the effect of increasing premiums by 7 percent rather than the projected 42 percent.
Insurers also have said that they need a guarantee from the federal government that it will give them cost-sharing reduction payments, which allow them to offer lower out-of-pocket costs to low-income customers.
President Trump has not committed to paying them in 2018. That has caused headaches for insurers that have been trying to decide for months whether to participate in Obamacare exchanges next year.
The Senate health bill that failed late Monday kept the cost-sharing payments for about two years before nixing them.
The Senate could appropriate the money for the cost-sharing reductions, which cost $7 billion last year, but it is not clear if they would be included in any bipartisan package.
Insurers are already feeling the effect of the uncertainty. Some have decided to raise rates by double digits because of questions about the cost-sharing payments and whether the government will enforce the law's individual mandate, which requires people to buy insurance or pay a fine.
Complicating matters for Congress and the White House is a House lawsuit challenging the legality of the payments. The House argued in the 2014 lawsuit that Congress should make the payments, not the White House.
A federal judge agreed and ruled that the payments should be appropriated from Congress, but she stayed her ruling until appeals from the White House were exhausted. The Trump White House hasn't said whether it plans to continue the appeal.
Republicans and Democrats have achieved bipartisanship on Obamacare before, as part of a budget agreement, but at the time each side used different semantics to describe the same policy outcomes. When Congress delayed the Cadillac tax on high-cost insurance plans and suspended the health insurance tax for a year, Democrats celebrated the move as an improvement to Obamacare while Republicans framed it as a dismantling of Obamacare.
Groups that represent insurers as well as small businesses have pushed Congress to again repeal or suspend the health insurance tax, which is projected to raise premiums by 3 percent to 5 percent next year. The suspension occurred this year to partially blunt unsubsidized premium increases in the exchanges, which still rose by 22 percent on average nationwide.
But while some lawmakers look ahead for options, others are hoping that Obamacare is repealed in some way, shape, or form. Republicans say they were frustrated that the 2015 bill may not pass even though a majority of Republicans that year voted for it.
"If the 2015 bill were to fail, I would say we would have a discussion and go to whatever repeal would pass," said Sen. Rand Paul, R-Ky. "There is some variation of repeal certainly that must pass or these people really don't believe what they said."