Senate Republicans have their counteroffer to the Democratic plan to extend Affordable Care Act subsidies — and the GOP proposal doesn’t extend the subsidies at all.
Instead, the plan is a bill that would replace the enhanced subsidies with direct-to-consumer Health Savings Accounts, or HSAs, alongside a host of other reforms.
“It actually does make health insurance premiums more affordable,” said Senate Majority Leader John Thune, R-S.D., who announced the move following a closed-door Republican lunch.
Both the GOP bill and a Democratic proposal are expected to fail when senators vote Thursday, leaving lawmakers with little more than two weeks to address the expiring ACA subsidies. When the subsidies disappear at the end of the month, Obamacare enrollees face sharp increases to their premiums which stand to, on average, more than double.
The Republican proposal is spearheaded by Sens. Bill Cassidy, R-La., and Mike Crapo, R-Idaho, who chair the Senate Health, Education, Labor and Pensions Committee and the Senate Finance Committee, respectively.
According to a summary of the plan, the HSAs would be paired with bronze and catastrophic plans on the Obamacare exchanges in both 2026 and 2027. Eligible individuals between 18 and 49 years old, who make less than 700% of the federal poverty level, would receive $1,000. Those between 50 and 64 years old would receive $1,500.
The legislation would bar HSA funds from being used for abortions or gender transition procedures. And the bill calls for several other health care changes, including a requirement that states check citizenship and immigration status before someone can join Medicaid.
Whether Democrats will universally oppose the bill remains unclear. Some Democrats may see a bit of money as better than nothing, though it’s clear most Democrats will hold out for a different offer, hoping Congress could extend the subsidies in some fashion at some point.
Republicans need seven Democrats to join them to overcome the 60-vote filibuster, assuming unified GOP support.
But it’s also unclear whether Senate Republicans will universally back the GOP bill. Thune would not promise “100%” support from his caucus.
Asked by reporters, Cassidy said he expected “very strong Republican support,” but added that the Republican caucus “is sometimes a herd of cats in a room full of rocking chairs.”
At least one moderate Republican, Sen. Lisa Murkowski of Alaska, indicated she has questions about how Cassidy’s plan would be implemented.
She also said she is concerned that it does not, at least temporarily, extend the ACA enhanced subsidies. “That’s the cliff that everyone is approaching in like two weeks,” she said.
Democratic leaders were quick to bash the offer.
Senate Minority Leader Chuck Schumer, D-N.Y., called it “junk insurance.”
“The bill not only fails to extend the tax credits, it increases costs, adds tons of new abortion restrictions for women, expands junk fees and permanently funds cost-sharing reductions,” Schumer said.
Democrats made extending the ACA subsidies a primary aim of their shutdown fight. And as part of the deal to end the funding impasse, Senate Republicans agreed to give Democrats a vote on a health care bill of their choosing by mid-December.
They did not, however, promise that the bill Democrats put up would pass.
While there were some bipartisan talks in the Senate about a joint path forward, those talks largely fizzled out. Then, last week, Senate Democrats introduced their own proposal: a three-year extension of the current subsidies.
That’s notably longer than what most Republicans have said is palatable for their party, and the Democratic offer has none of the changes that Republicans have demanded.
Up to now, Republicans have failed to coalesce around a single counterproposal to the Democratic push to extend ACA enhanced subsidies — the latest flare-up in a 15-year struggle for Republicans to counter Obamacare.
On Monday alone, rank-and-file GOP senators rolled out three different health care frameworks — including the proposal from Cassidy and Crapo. (Unlike the plan Cassidy-Crapo plan that GOP leadership has decided to advance, the other two included at least a partial extension of the enhanced subsidies — with reforms — as an offramp.)
A plan proposed by Sens. Bernie Moreno, R-Ohio, and Susan Collins, R-Maine, for instance, included what they described as a “two-year glidepath” to end the enhanced premium tax credits. It would impose a $200,000 household income upper limit for the enhanced premiums and require a $25 minimum monthly payment for enrollees — aimed, they say, at combating fraud in the system.
And a separate pitch from Sen. Roger Marshall, R-Kan., called for extending the enhanced subsidies for a year with changes including ID verification and minimum monthly premium payments. Beginning in 2027, his plan says, the money used for the enhanced premiums would then be diverted into HSA-style accounts.
Marshall’s office described those HSA accounts as “Hyde-protected” — a reference to the Hyde Amendment, which bans federal funds from being used for abortions except in cases involving rape, incest or when the life of the mother is at risk.
Democrats have repeatedly objected to GOP attempts to increase abortion restrictions in any health care bill.
After Thursday’s votes likely fail, the question is, what happens then?
Some lawmakers are holding out hope that failure could inspire a renewed interest in bipartisan talks. Those talks would likely drag into January at least — after premiums have already skyrocketed and, notably, when there’s another government funding deadline just around the corner at the end of the month.
“You understand this is all a bunch of play-acting,” Sen. John Kennedy, R-La., said of the votes this week, saying the GOP plan is “not going to pass. Neither is Chuck’s proposal.”
“So we’re back at square one,” he said.
Jack Fitzpatrick and Mychael Schnell contributed to this report.
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