Senators have about a week before they’re set to vote on soon-to-expire Affordable Care Act subsidies. Most of them already believe the chances for a bipartisan breakthrough by then are roughly zero.
There’s no clear momentum for any plan that would avoid a lapse in tax credits that could raise insurance premiums for 20 million Americans. House and Senate members involved in the talks said Monday they are still trading ideas, and Congress is in the dark about whether President Donald Trump will roll out an 11th-hour framework for an extension, which could help provide a needed boost.
“Right now, it’s not on a fast track,” Sen. Markwayne Mullin (R-Okla.) said about the chances for a health care deal.
Instead, the most likely outcome is that Senate Democrats put up a bill that has little GOP support for a vote, if any, while Republicans offer a competing bill of their own. And even those partisan proposals remained in flux as lawmakers returned to Washington from a weeklong recess.
Sen. Jeanne Shaheen (D-N.H.), who has been a key figure in the bipartisan negotiations over a potential extension, said that while she still believes there is time to craft a compromise proposal before the vote, it “remains to be seen” if people are willing to move that quickly.
On a separate track, GOP Sens. Mike Crapo of Idaho and Bill Cassidy of Louisiana are working behind the scenes on a bill meant to serve as the Republican counterproposal to whatever Democrats offer, according to three people granted anonymity to discuss private deliberations. Aside from the unsettled substance of the bill, when it might be unveiled remains in question.
Senate Majority Leader John Thune and two other people familiar with internal conference discussions didn’t rule out a vote on a GOP health care plan next week but would not commit to that timing.
“We’ll see what the Dems want to put up,” Thune said Monday. “There’s obviously something that we could put up as a side-by-side, neither of which would probably get 60 [votes to advance], but I think in the end you would like to see if there’s a path forward on something that could merge.”
Some Senate Republicans don’t see the point in forcing a symbolic vote on a GOP counterproposal.
“I don’t want to take a vote just for the heck of it,” said Mullin, who spoke with Trump about health care last week. ”If we’re going to vote, let’s make sure we do something that’s going to be productive.”
Health care is expected to be the dominant topic at both Senate party lunches Tuesday. Democrats will use the closed-door meeting to talk through their options, which include offering a “clean” extension of the ACA subsidies — which few Republicans support — or an extension paired with GOP-favored eligibility restrictions as an olive branch to conservatives.
Senate Republicans are facing their own dilemma — and internal divisions — over which approach to take. Some, like Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, have backed an extension of the subsidies, but a chunk of the Senate GOP conference, to say nothing of their counterparts in the House, want to end the subsidies cold turkey.
Many Republicans, including Cassidy, are focused on alternatives that would structure federal health care subsidies around health savings accounts, an idea that Trump has also endorsed. But lawmakers agree there is virtually no time to develop and implement such a system before the existing subsidies expire, leading some Republicans to favor a temporary extension.
Murkowski said she is “very hopeful” about the bipartisan talks underway but acknowledged the time pressure: “The calendar is not necessarily our friend right now.”
Nor, for now, is Trump, who appears to be sitting on the sidelines even as some congressional Republicans are begging him to get involved and sketch out a health care plan that could help unite and energize GOP factions in the House and Senate.
The president appeared poised to roll out a plan late last month that would extend the ACA subsidies with an income cap and other eligibility restrictions. But the White House scuttled that plan amid a mountain of GOP backlash.
“I think without White House leadership, we’re not going to have a well received product,” said Sen. Thom Tillis (R-N.C.), who has backed a temporary extension. “If we produce something in the Senate, it won’t be well received in the house unless the president works his magic, which he’s very capable of doing.”
Thune said Monday he doesn’t believe the White House is “advocating for advancing anything at the moment,” while making the point that health care talks could continue past next week’s votes. Lawmakers increasingly view Jan. 30 — the next government funding deadline — as the real cutoff for a health care deal.
“I think there’s, you know, groundwork being laid that could end up in actually something getting done,” he said. “I just don’t know if it can get done by next week. That’d be a pretty heavy lift.”
Meanwhile, House Republicans are on a separate track altogether, with party leaders looking to assemble a suite of health care bills from three committees — Ways and Means, Energy and Commerce, and Education and Workforce. Their plan is less about making law, which would require buy-in from Senate Democrats, and more about showing voters that Republicans have plans to address rising health care costs.
Under pressure from unhappy GOP centrists, House leaders are tentatively planning to put legislation on the floor before the chamber’s scheduled Dec. 18 departure for the holiday recess. But that could change. The Ways and Means and Energy and Commerce panels are holding listening sessions with Republican members this week, indicating their plans remain in development.
“We want to get it done as soon as we are ready to get it passed,” Majority Leader Steve Scalise said in a brief interview Monday.
Some GOP chairs raised questions and made messaging suggestions on health care during a leadership meeting Monday with Scalise, according to four people granted anonymity to describe the private conversation. One of the people added that there’s still “not a lot of direction” from Republican leaders on the topic, and even conservative Republicans are rankled that no firm proposals are being circulated widely inside the conference with just 11 scheduled session days remaining in the year.
“We’re nowhere on health care,” said one senior House Republican who was granted anonymity to candidly describe the situation.
Republican leaders are also under pressure from some House GOP centrists who are threatening to use a discharge petition to effectively force a subsidy extension bill to the floor.
One of those centrists, Rep. Brian Fitzpatrick of Pennsylvania, said Monday he has spoken with the White House about a bill he is working on and shopping around to colleagues, which would largely mirror Trump’s unreleased framework.
“It’s one of those things where nobody’s going to love it,” Fitzpatrick said. “But hopefully enough people are okay with it.”