The fierce fight over health care costs hits a crucial juncture this week, with a series of major developments that could make or break the future of enhanced ObamaCare subsidies.
For months, GOP leaders have been squeezed between centrist Republicans clamoring to extend the Affordable Care Act (ACA) tax credits, which expire at year’s end, and more conservative lawmakers fighting to see them lapse. Democrats, from the sidelines, have fueled the clash by demanding a “clean” extension to prevent premiums from skyrocketing for millions of Americans in January.
Those fights all come to a head this week, when Speaker Mike Johnson (R-La.) is expected to introduce a leadership-endorsed health care plan; the Senate is set to vote on the Democrats’ three-year extension; and Rep. Brian Fitzpatrick (R-Pa.) is vowing to introduce yet another bipartisan blueprint he says has the best shot of actually becoming law.
“We’re just trying to thread a needle to get to 218 and 60 [votes], that’s it,” Fitzpatrick said. “I think it’s the most serious attempt out there.”
This week’s Senate vote is the result of a deal that ended the historic 43-day government shutdown. But while Senate Majority Leader John Thune (R-S.D.) promised a vote on extending the subsidies, there was no guarantee of Republican support. The plan Senate Minority Leader Chuck Schumer (D-N.Y.) will bring up aims to extend the premium subsidies for three years, but it is expected to fail.
Various groups of Republican and Democratic moderates, meanwhile, have put forward their own proposals to extend the subsidies while implementing reforms like income caps and an elimination of plans without premiums.
Republican division on how to approach the subsidy expiration deadline is only increasing the anxiety those in the party are feeling about communicating an affordability message as they enter a midterm election year when control of the House is very much in play.
Swing-seat Republicans at risk of losing their seats are the loudest voices in favor of extending the subsidies in some form, so constituents aren’t faced with hefty premium increases caused in part by the subsidy expiration.
“A lot of my friends, a lot of people I know, won their elections by 1 or 2 [points]. So do I think that if you won your election by 2 points that it matters? Absolutely. It makes a big difference,” said Rep. Jeff Van Drew (R-N.J.).
“It’s not just political buzzwords,” he continued. “I’ve talked to die-hard, ruby-red Republicans that are really concerned and upset about this. This is a huge increase in costs.”
But a large number of conservatives in the party, who have long railed against ObamaCare and balked at the subsidy enhancements when Democrats enacted them during the COVID-19 pandemic, staunchly oppose any extension out of principle.
Plus, many anti-abortion Republicans will refuse to vote for any plan that fails to impose explicit prohibitions on ACA health plans that cover abortions. None of the proposals being floated by centrist Republicans include such language.
One House Republican who spoke to The Hill said that there is broad recognition in the conference that a bipartisan deal to extend the health care subsidies is exceedingly unlikely because of those dynamics and wondered why GOP leaders have not yet ruled out that possibility.
GOP leaders have been hinting that the health care plan they are expected to unveil this week will consist of alternative health care affordability proposals beyond the subsidies. Republicans for weeks have been discussing ideas like expanding access to health savings accounts — all while reviving longtime attacks on ObamaCare as a failed, expensive program.
House Majority Leader Steve Scalise (R-La.) said last week that there is “nothing affordable about the Affordable Care Act.”
“We’re going to keep bringing bills to the floor to do those two things, to lower premiums for families and give them options so that they can get what’s best for their families,” Scalise said. “They don’t have to be forced into a plan that the government tells them they have to be in that’s too expensive for them. It doesn’t work for their family, they can buy whatever they want that makes sense for them and for their family.”
But any legislation that features a conservative health policy wish list, without extending the ObamaCare subsidies, has little chance of passing through the Senate, where Democratic support is vital to securing the 60 votes needed to defeat a filibuster. Faced with that mathematical reality, some centrist Republicans are urging GOP leaders not to pursue a partisan messaging bill that has no chance of becoming law.
“Having accounts — spending accounts and having health savings accounts — that’s a good idea, and maybe we should even do that,” said Van Drew. “But it’s not going to do it in itself right now.”
Fitzpatrick, a co-chair of the bipartisan Problem Solvers Caucus, was even more blunt.
“If it’s not a two-party solution, it’s not a serious attempt to fix the problem,” he said. “What good does it do to put a Republican-only bill on the floor that’s not [going to become law]?”
Asked if a vote must happen by the end of the year, Fitzpatrick didn’t hesitate: “100 percent,” he said.
And as a last-gasp strategy, Fitzpatrick is vowing to pursue a discharge petition to force such a vote if GOP leaders refuse to stage it themselves. That process is typically time-consuming, but he says there are several “shells” available that have already “ripened” according to House rules, allowing supporters of an ACA subsidy extension to move legislation to the floor before year’s end.
“We’ve received no commitments [from leadership],” he said. “But we have commitments to each other that we’re going to get a bill to the floor.”