“Democrats will have to agree to something — more flexibility for states — that some are reluctant to support. And Republicans will have to agree to something — additional funding through the Affordable Care Act — that some are reluctant to support,” he said.

Timeline for bill

Alexander said his hope is to pass a bill by the end of the month. The Senate is just returned from its summer break, and is convening a series of hearings on the Affordable Care Act. Their efforts are up against a stacked legislative agenda, however. Congress is looking at bills on hurricane relief, funding the government beyond September, raising the debt ceiling and renewing the Children’s Health Insurance Program.

Related: ACA specialty drug prices remain problem for consumers

Senator Susan Collins, the Maine Republican who was one of three votes against repealing Obamacare in July, dooming the GOP effort, called the hearings -- which Republicans declined to hold during their repeal effort -- a promising first step.

“They will help us come up with a solution to help further stabilize the markets and correct a few, not all, but a few of the flaws in the ACA,” Collins said Tuesday.

It’s likely, said Collins, that some of those efforts could be combined into a single bill in order to get it through both chambers. Yet other items, such as debate over tax reform, immigration, and investigations into the Trump administration and the election, could become obstacles.

Insurance commissioners

The Senate committee hearing Wednesday features five state insurance commissioners from Tennessee, Pennsylvania, Alaska, Washington and Oklahoma. Most of the commissioners, in prepared remarks, strongly backed funding payments that go to health insurers to reduce low-income patients’ out-of-pocket medical costs. Known as cost-sharing reduction subsidies, or CSRs, the Trump administration has threatened to stop making the payments.

“The CSR funding issue is the single most critical issue that you can address to help stabilize insurance markets for 2018 and potentially bring down costs,” Tennessee’s insurance regulator Julie Mix McPeak said in prepared testimony.

As Congress debates changes to the law, health insurers and state regulators are putting the finishing touches on how it will operate and what health coverage will cost next year. Insurance companies were required to submit their 2018 premiums to regulators in many states on Sept. 5, though there’s some room for changes if Congress takes action.

McPeak said carriers in her state could reduce rates if Congress decided to fund the cost-sharing reduction payments by about Sept. 20. BlueCross BlueShield of Tennessee and Cigna Corp. told state regulators that 14 percentage points of their overall 21 percent and 42 percent average rate increase, respectively, was due to uncertainty around the payments.

Other proposals

Some of the insurance commissioners also called for funds to help insurers offset the costs of abnormally high claims, a concept known as reinsurance, and backed more flexibility.

The insurance commissioners also called for action on pharmaceutical costs, and Trump has previously promised to bring down “astronomical” drug prices though hasn’t taken any major action.

“We need to have a serious national conversation about how we can moderate the unsustainable growth in health care costs, especially in areas experiencing astronomical growth in cost like we currently see with pharmaceutical costs,” Teresa Miller, acting secretary of Pennsylvania’s Depart of Human Services and former insurance commissioner for the state, said in prepared remarks.

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