The U.S. Congress was wrestling with health care again Tuesday, as lawmakers from both parties considered some approaches beyond simply repealing and replacing Obamacare.
The widened health care discussion appeared unlikely to yield dramatic changes soon, but marked a shift from the long-running Republican effort to gut 2010's Patient Protection and Affordable Care Act, as Obamacare is formally known.
Republicans' last attempt in July to overturn former Democratic President Barack Obama's signature health care law fell one vote short in the Senate in a humiliating defeat for President Donald Trump and Senate Majority Leader Mitch McConnell of Kentucky.
In one Senate committee, a bipartisan effort was under way on Tuesday to repair Obamacare without repealing it, led by the Republican health committee chairman, Lamar Alexander of Tennessee, and the panel's top Democrat, Patty Murray of Washington. They want to stabilize the Obamacare individual insurance market by protecting its "cost-sharing subsidies."
Those payments go to insurers to help reduce out-of-pocket medical expenses for low-income Americans enrolled in Obamacare.
Trump, who made repealing and replacing Obamacare a major campaign promise, has repeatedly threatened to stop the payments, which insurers say would force a 20 percent premium price increase.
Alexander, who also wants states to have more flexibility to design health insurance plans under Obamacare, said on Tuesday the goal was a "small bipartisan step" that could break the years-long partisan stalemate over the law.
The senator said he hoped to have a bipartisan consensus proposal by next week, although it was unclear whether McConnell would bring such a measure to the floor. He was noncommittal when asked about it Tuesday.
Some Republicans were supportive. Wisconsin Senator Ron Johnson said if the government did not keep funding the cost-sharing subsidies, insurance premiums would most likely rise and the government would have to spend more money on tax credits that help consumers afford the premiums.
"The insurance companies get their money either way," Johnson told Reuters.
Maine Republican Susan Collins, who voted against repealing and replacing Obamacare in July, said she hoped to support the bipartisan Obamacare repair effort.
"Based on the hearings so far, [I] would expect to," she said.
The effort was being watched closely by companies such as Anthem, which has trimmed the number of states and counties in which it will sell Obamacare plans in 2018.
The company said on Tuesday that it was still working with some state regulators on its market participation for next year. Anthem and other insurers have a deadline of September 27 to finalize their 2018 Obamacare roles.
Separately, independent Senator Bernie Sanders of Vermont, a 2016 Democratic presidential candidate, was pushing a plan to widen the Medicare health insurance program for seniors, to include everyone.
Most Republicans looked askance at the idea, which Sanders has long championed, while some leading Democrats like House Democratic Whip Steny Hoyer of Maryland said their priority was improving Obamacare.
The Republican anti-Obamacare campaign was not entirely over. Two Republicans were planning to announce a new repeal-and-replace proposal on Wednesday that has White House support.
Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana will offer legislation to give states money in the form of block grants instead of the federal funding states get under Obamacare.
Critics said the approach would effectively cut billions of dollars in funding for Obamacare subsidies and for the Medicaid program for the poor that many states expanded under Obamacare.
The Cassidy-Graham bill must pass by the end of September to comply with Senate procedural rules allowing it to advance with a simple majority, rather than the 60 votes needed for most bills.
"It would take an extraordinary lift to get that done before the deadline," said Senator John Thune of South Dakota, a member of the Republican leadership.