President Trump’s trial balloon for extending the Affordable Care Act’s enhanced subsidies has been shot down, but the real moment of truth for him and Congress may come in the run-up to the next government funding cliff, in late January.
Why it matters: There still are multiple scenarios for preventing steep increases in premium costs for millions of Americans heading into an election year dominated by affordability issues.
- Before Republicans pushed back against this week’s effort, Trump had broached the prospect of a health care deal that would coincide with the Jan. 30 deadline for funding the government.
Here are five ways the ACA subsidy drama could play out, ranked roughly from most to least likely:
1. Dueling health care votes fail, subsidies expire
It’s usually not a bad bet to assume gridlock will win out in Congress. And that appears to be in the cards as Democrats await the subsidy vote they were promised by Dec. 12 as part of the deal to end the government shutdown.
- The most likely scenario is that Democrats propose a clean subsidy extension that fails to get the 13 Senate GOP votes needed to extend the tax credits.
- Republicans could offer an alternative, although it’s not yet clear what that would look like since the Trump plan is on hold. Any GOP-only plan would also fail to get the required 60 votes.
- With the parties canceling each other out, the subsidies would expire on Dec. 31.
2. Plot twist: Revival in January
It’s possible that after that, the parties find it in their mutual interest to hash out a deal — perhaps with more health policy add-ons.
- Sources say there is some chance of assembling a package ahead of the next government funding deadline that could include other health priorities like an overhaul of pharmacy benefit managers’ business practices.
Between the lines: The timing of a January deal would be awkward, after the subsidies have already expired. But the thinking is the out-of-pocket costs hitting home for consumers could light a fire under Republicans.
- In theory, Congress could even create a special ACA enrollment period to extend the time to sign up.
- Trump floated this deadline in a Fox News Radio interview on Friday, saying of a health care deal, “We have a January 30 date coming up. I’d like to see if we could do it by then.”
- Still, there are other significant hurdles, not least of which is the GOP’s insistence on more restrictions on subsidy money being used on health plans that cover abortions.
3. Bipartisan proposal passes Senate, fails in House
There are still some Senate Republicans who want at least a temporary extension by the end of the year and are worried about the political fallout in red states from the premium hikes.
- If Democrats are willing to limit eligibility for subsidies, there’s a chance some Republicans could sign on.
- The changes could come in the form of an income cutoff for the enhanced subsidies and requiring recipients to pay a minimum amount in premiums per month, which Republicans say would cut down on fraud.
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- The abortion funding restrictions would still hang over any discussions.
Yes, but: Even if there are enough votes for a compromise in the Senate, the measure could fail in the House, where GOP leaders are more dug in. Speaker Mike Johnson has notably not even promised a subsidy vote in the House.
- He has warned the White House that most House Republicans don’t want to extend the subsidies, the Wall Street Journal reported.
4. Bipartisan proposal passes both chambers and gets signed into law
It’s not out of the question the two parties could reach a last-minute extension deal in December — though that’s not a lot of time for Republicans, who don’t want to extend the subsidies in the first place, to decide what they can live with.
- To get through the House, Trump would likely have to make a major push for any deal. That seems far off at the moment: Trump has been regularly blasting the subsidies in Truth Social posts, though the plan he floated did include a subsidy extension with conditions.
- Still, Trump is unpredictable and could decide to back some kind of deal.
5. A GOP-only reconciliation bill
If Republicans are feeling political heat to show some action on health care, they could always try to go it alone with another partisan reconciliation bill.
- The White House has also floated this idea and there is some talk about it on Capitol Hill as well.
- Still, there are major headwinds. The process would be time-consuming, and it’s not yet clear there are the votes for a GOP-only plan.
- It’s also not clear what the GOP-only plan would be.