After months of different deadlines to extend Obamacare subsidies, Congress is finally confronting its last real chance to renew the enhanced tax credits before premiums spike for millions of Americans on Jan. 1.
Lawmakers in both chambers return Monday for their final legislative week of the year, and House Republicans are preparing their first attempt to address the looming deadline.
It’s likely to fail.
Sometime this week, the House will vote on a GOP-crafted health care package that — notably but unsurprisingly — doesn’t include any extension of the enhanced Affordable Care Act subsidies.
“Nearly 15 years ago, the Democrats’ Unaffordable Care Act broke the American health care system,” Speaker Mike Johnson, R-La., said in a statement rolling out the GOP’s proposal.
But as a concession to moderate Republicans concerned about the political fallout of letting the subsidies lapse, Johnson is allowing a vote on an amendment based on a bipartisan bill from Rep. Brian Fitzpatrick, R-Pa. His legislation would extend the subsidies for two years and implement a number of other changes.
What exactly that amendment will do, however, remains unclear. Two sources who were in a meeting with Johnson and leaders from across the conference on Friday told MS NOW that conservatives are pushing for even more changes to the Fitzpatrick amendment.
One of those sources told MS NOW over the weekend that things are “still in flux” and sounded pessimistic about landing a product. “It just seems like everyone is too far apart,” the source said.
The amendment will need a majority vote in the House to be adopted, which could happen if Democrats get behind the proposal. But the more changes conservatives can pile onto the amendment, the less likely it is that Democrats will get behind it.
Still, even if Democrats don’t vote for the Fitzpatrick amendment, the vote will likely accomplish one big goal for the House GOP: to give vulnerable Republicans the chance to go on record in support of extending the subsidies.
“There’s perhaps no single policy measure that would have a more dramatic impact on affordability in the year ahead than doing something about the expiration of these subsidies,” said Rep. Kevin Kiley, R-Calif., who district was divvied up as part of the Democratic-led redistricting effort in California.
“If we go home without addressing that, that is a huge problem,” Kiley said.
Politically, however, the vote could also hand Democrats ammunition ahead of the midterms — offering a clear list of Republicans who declined to act before premiums soared.
For months, Democrats have argued that if ACA premium prices skyrocket, they will make Republicans “own it.”
“If they don’t extend these tax credits,” Rep. Jim McGovern, D-Mass., recently told MS NOW, “we’re going to wrap this around their necks.”
But Republican leaders don’t seem too concerned — with Johnson and others preferring not to act than shoring up Obamacare.
In a sign of the GOP bill’s slim chances of clearing the House and moving to the Senate, House Minority Leader Hakeem Jeffries, D-N.Y., balked at the proposal hours before it was unveiled, saying that while the Fitzpatrick amendment may be palatable, the entire package is likely not.
“The bill will cause millions of people to lose coverage, promotes junk health insurance plans and further limits the freedom of women to make their own reproductive health care decisions,” Jeffries said in a statement.
The House GOP bill includes an assortment of policy ideas. It would codify and expand association health plans and also give employers — particularly small business owners — the option to provide funds to workers so they can pick their own individual health plan, instead of offering a traditional group benefit.
The proposed legislation also would appropriate money for cost-sharing reductions to reduce premiums in the individual ACA market and require Pharmacy Benefit Managers (PBMs) to be more transparent with employers. And the measure includes language to, Republicans argue, protect small businesses that fund their own health plans from going bankrupt over surprise expensive claims.
It does not, however, include an expansion of health savings accounts, which President Trump has pushed as an alternative to extending the subsidies.
Again, the legislation seems destined to fail.
But while the House GOP proposal will take center stage this week, lawmakers are working on other efforts to address the subsidies behind the scenes, though it’s unclear if any other proposal will get a vote before the subsidies expire.
In addition to being the basis for the amendment vote, Fitzpatrick’s bill has also been filed as a discharge petition, with lawmakers looking to circumvent leadership and force a vote on Fitzpatrick’s original legislation. Thus far, 24 members have signed on — 12 Republicans and 12 Democrats, which is far short of the 218 needed.
But there’s another discharge petition also in the works. Rep. Josh Gottheimer, D-N.J., is working on forcing a vote for his bipartisan bill, which includes a one-year extension of the enhanced subsidies alongside some reforms. Gottheimer’s discharge petition has 39 lawmakers onboard — including 11 Republicans — and Democratic leaders have indicated they could support his legislation.
Already, both petitions have enough GOP buy-in that, with the support of all Democrats, they could reach the 218 threshold needed to force a vote. It remains unclear, however, if Democrats will throw their full weight behind either bill.
When MS NOW asked Jeffries about the Fitzpatrick and Gottheimer discharge petitions, the minority leader said Democrats were “actively reviewing” both of them. “And we’ll have more to say about it early next week,” Jeffries said.
Jeffries has his own discharge petition, with signatures from all Democrats, that would extend the subsidies for three years — a proposal that is a nonstarter for just about every Republican.
But it’s not just Jeffries who’s staying coy.
When MS NOW asked House Democrats if they would sign onto either of the discharge petitions, lawmakers were noncommittal.
“To me, it’s about affordability, but it’s also about accessibility,” Rep. Paul Tonko of New York, said. “And a lot of these services were being cut, and so I want to make certain that we’re not sacrificing really deeply.”
Rep. Alexandria Ocasio-Cortez, D-N.Y., took issue with new potential changes restricting who could receive the subsidies. “If the reform is we’re going to pretend that we’re extending these subsidies, but make people actually, secretly ineligible for them, so that someone can look good — no, I don’t support that,” Ocasio-Cortez said.
“But if there’s a compromise we can make that’s actually going to help people, yeah,” she continued.
And Rep. Joseph Morelle, D-N.Y., touched on another key dynamic as to whether either of these discharge petitions could actually address the pending premium problems: the upper chamber on Capitol Hill.
He said what could pass the Senate was “the big question.”
But the reason attention has shifted so quickly to the House is that the Senate last week failed to pass any health care proposal.
One plan, a Democratic proposal, would have extended the enhanced subsidies for three years. It did not, however, include the reforms Republicans have been seeking, such as income caps.
The counteroffer, put forward by Republicans, didn’t extend the subsidies at all, instead replacing them with Health Savings Accounts (HSAs) — a proposal that Democrats argued would not adequately compensate for the premium increases.
While some senators hope the failures will springboard renewed interest in bipartisan conversations in the Senate, those talks haven’t gone anywhere in recent weeks.
If there is suddenly progress in the Senate, many suspect this will not be resolved until January — after enrollees are already forced to grapple with higher prices.
“We’re up against deadlines already,” Sen. Catherine Cortez Masto, D-Nev., told MS NOW. “We have to come together.”
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