Repeal and replace or end the health payments

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This is the second major blow dealt to the Republican effort to repeal Obamacare, causing some in the party to doubt if the GOP can get a bill to President Donald Trump's desk.

For seven years, Republicans have promised that once they took power, they would scrap Obama's overhaul and pass a replacement.

On Friday, House Republicans gathered for a conference where they bemoaned the Senate's dysfunction, playing at the top of their gathering Gordon Lightfoot's "The Wreck of Edmund Fitzgerald", a song about a ship disaster.

Trump later urged Senate Republicans to try again on a healthcare vote.

The Senate has one vote scheduled when it reconvenes on Monday afternoon: whether to confirm a US circuit court judge. GOP Sen. John McCain went home to Arizona for cancer treatments.

Trump, frustrated that he and Republicans have not been able to follow through on their campaign promises to repeal and replace Obamacare, has repeatedly threatened to let it implode. The Senate is in session for another week before it is scheduled to begin an August recess. McConnell has said the unfinished business includes addressing a backlog of executive and judicial nominations, coming ahead of a busy agenda in September that involves passing a defence spending bill and raising the government's borrowing limit. House Republicans, who passed a comprehensive repeal-and-replace bill, say that if something is going to happen on health care it will have to come from across the Capitol.

The Senate's failure to pass the GOP health care bill, said Alexander, "leaves an urgent problem that I am committed to addressing". Charles Schumer, D-N.Y., the minority leader, said health care costs would rise for millions of Americans if the federal subsidy for insurance markets is scrapped.

To appease lawmakers, the Obama administration quietly made an exception and created a carve-out for members of Congress and their staffs - a change that was ratified in 2015 as part of a congressional waiver.

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On Saturday, Trump tweeted: "If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!"

Their main concern now is that the administration will stop paying crucial subsides called for in the law that help reduce costs like deductibles for people with low incomes.

Soaring prices and fewer choices may greet customers when they return to the Affordable Care Act's insurance marketplaces this fall, in part because insurers are facing deep uncertainty about whether the Trump administration will continue to make key subsidy payments and enforce other parts of the existing law that help control prices. On Friday, health-care analyst Spencer Perlman at Veda Partners LLC said in a research note that there's a 30 percent chance Trump will end CSR payments, which may "immediately destabilize the exchanges, perhaps fatally".

The payments are the subject of a lawsuit brought by House Republicans over whether the health law specifically included a congressional appropriation for the money, as required under the Constitution.

"If the CSR payments end. insurers would face significant revenue shortfalls this year and next", the Kaiser Family Foundation wrote earlier this year when Trump was noncommittal to Obamacare subsidies. "Demand another vote before voting on any other bill!"

That tweet appeared to be referring to the approximately $8 billion in cost-sharing reduction subsidies the federal government pays to insurers to lower the price of health coverage for low-income Americans.

Although Trump's tweet could be read to suggest he plans to do something about what members of Congress pay for their health insurance, it's not clear what that could be.

"I certainly hope the administration does not do anything in the meantime to hasten that collapse", she added. He has indicated a desire to halt the subsidies but so far has allowed them to continue on a month-to-month basis.

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