Health Care

Alexander-Murray: A Bipartisan Deal to Block Trump’s ACA Sabotage

After weeks of negotiations, Senator Lamar Alexander of Tennessee and Senator Patty Murray of Washington announced on October 17 that they had reached an agreement on several “fixes” to stabilize health insurance markets. After months of sabotage by the Trump administration, this bipartisan bill—which has the support of 12 Republican senators and all 48 Democratic senators—has enough backers to pass the Senate and begin to undo some of the damage Trump has done. However, it faces an uncertain path to becoming law. It’s time to stop the sabotage: Tell your MoC to support this bipartisan effort, and that the only acceptable changes to Alexander-Murray are those that would go further to protect people’s care.

What Alexander-Murray Would Do

Negotiations on Alexander-Murray took on increased urgency after Trump’s latest round of health care sabotage on October 12, when he announced he would stop making cost-sharing reduction payments. The bill seeks to stabilize individual health insurance markets by:


  • Guaranteeing that cost-sharing reduction payments are made. Cost-sharing reduction (CSR) payments are made by the government to health insurance companies to help low-income families afford their out of pocket expenses. Alexander-Murray guarantees that insurers will receive CSR payments for two years. Allowing Trump to kill these payments would have cost the government an extra $194 billion over the next 10 years and resulted in higher premiums and fewer insured Americans, which means guaranteeing that insurers receive the payments saves the government money and keeps more people covered.
  • Restoring funding for enrollment outreach. Trump slashed the budget for open enrollment outreach by 90% because he thinks sowing confusion will reduce enrollment, which will undermine the Affordable Care Act (ACA). (And unfortunately, most people aren’t aware that open enrollment starts on November 1.) Alexander-Murray would restore $106 million in funding, which would restore all of the money that Trump tried to unilaterally cut from the budget.


In order to get the Republicans to agree to these changes, Democrats had to make some concessions: namely, that states have more “flexibility” to make changes to their individual marketplaces, and that more people are allowed to buy “copper” plans (which are low-cost, high-deductible plans that don’t cover more than the bare minimum). The deal isn't perfect, but it's far better than Trump's unchecked sabotage of the ACA and open enrollment.

Uncertain Prospects for Passage

While the bill has enough support to pass in the Senate, we don’t know if Mitch McConnell would bring it to the floor for a vote. It also faces considerable opposition in the House, and from the White House.


  • In the Senate, Mitch McConnell has not committed to bringing Alexander-Murray to the floor for a vote—even though it certainly has enough support to pass.
  • In the House, Paul Ryan announced that he does not support Alexander-Murray—a significant blow to the bill’s chances of passage, since he controls what comes to the House floor. Representative Mark Walker, the Chairman of the hardline Republican Study Committee, also bashed the deal. It is unclear if Alexander-Murray has enough support to pass, even if it did make it to the floor
  • In the White House, Trump is pushing for changes that would do even more damage to the health insurance marketplaces than simply maintaining the status quo, like repealing provisions of the ACA that lower costs for everyone.


If Alexander-Murray can’t pass as a standalone bill, Democrats may demand that Republicans include it in the upcoming government funding bill in December. Since Republicans won’t have the votes to pass a funding bill on their own, Democrats have leverage to push for some of their key priorities—including Alexander-Murray.

What We Need to Do

Let’s be clear: we only support this deal because we believe it is critical that Trump not be allowed to sabotage our health insurance system, which would hurt millions of people. Democrats must hold the line against any destructive changes the White House or conservative Republicans want to this deal, such as making it easier to siphon people off into skimpy, inadequate insurance plans. The only changes Democrats should accept are ones that would make Alexander-Murray stronger, such as a provision to block Trump’s executive order that will expand the availability of junk plans. Tell your MoC to support this bipartisan effort, and that the only acceptable changes to Alexander-Murray are those that would go further to protect people’s care.

Sample Call Script

Caller: Hello! My name is [___] and I’m calling from [part of state]. I’m calling to tell [Congressman / Senator __] that I want [him / her] to support the bipartisan deal made by Senator Alexander and Senator Murray to protect the health insurance markets from Trump’s sabotage.

If the MoC does not support Murray-Alexander:

Staffer: The [Congressman / Senator] thinks that the Affordable Care Act is failing, and that we should focus on repealing and replacing the ACA instead of throwing money at a broken system.

Caller: Actually, the ACA was working well until Trump started undermining it. His actions have driven up premiums for millions of people, and are going to lead to a death spiral unless [Congressman / Senator] _______ acts to stop him. Insurance companies that pulled out of markets said they did so because of Trump’s deliberate sabotage.

Staffer: Democrats will not agree to changes that would give the American people control over their own health care. The deal as it is now is just a bailout for insurers.

Caller: None of the money in this deal is going to go to “bail out” insurers; it’s to ensure that low-income people have access to health insurance.

Staffer: I’ll pass along your thoughts to the [Congressman / Senator].

If the MoC does support Murray-Alexander:

Staffer: The [Congressman / Senator] supports this deal; [he / she] knows how important it is to protect [his / her] constituents’ coverage.

Caller: That’s great. I’m very glad the [Congressman / Senator] is ready to act to protect [his / her] constituents’ coverage. Will the [Congressman / Senator] also commit to voting against destructive changes to the bill if there are further negotiations?

If the MoC does commit to opposing changes:

Staffer: The point of this bill is to stabilize the markets, not continue to undermine them; the [Congressman / Senator] will oppose any changes that are counter to that goal.

Caller: I’m glad to hear it; it’s well past time to stop Trump from sabotaging the health insurance markets.

If the MoC does not commit to opposing changes:

Staffer: The [Congressman / Senator] feels that there is still room to improve this deal; a lot of Americans are suffering under the ACA, and we need to do everything we can to stop that.

Caller: None of the changes that conservative Republicans want would do anything to help people get affordable coverage; the [Congressman / Senator] needs to know that this deal is the best opportunity we have to protect the constituents that [he / she] is concerned about protecting.