With just two weeks to go until Affordable Care Act subsidies expire, top Republicans on Capitol Hill are now conceding that, for all the seeming action on health care, premiums are almost certain to skyrocket on Jan. 1.
In the House, lawmakers are set to take a vote on a GOP health care proposal Wednesday that stitches together a grab bag of conservative ideas, including expanded association health plans, cost-sharing reductions in the ACA marketplace and new transparency requirements for pharmacy benefit managers. (Notably absent from the bill is an extension of the enhanced premium subsidies under the ACA, also known as Obamacare.)
But all that vote will do is demonstrate that Republicans can pass a partisan bill in one chamber — if the bill passes at all.
There are real questions about whether Republicans will actually be able to muscle their proposal through the House. And that would be the easy part. With the 60-vote threshold in the upper chamber, there’s little chance the legislation will go anywhere but a Senate filing cabinet.
“We’re not going to pass anything by the end of this week,” Senate Majority Leader John Thune, R-S.D., said Tuesday, before adding that there could be a “pathway” to a deal in January “if Democrats are willing to come to the table.”
Of course, by January, premiums will already have gone up for millions of Americans getting their health insurance through the ACA marketplace. Many enrollees are expected to see their premiums more than double when the enhanced Obamacare subsidies expire at the end of this month.
Senate Minority Leader Chuck Schumer, D-N.Y., argued Tuesday that there’s no time to waste, telling reporters, “After Jan. 1, the toothpaste is out of the tube.”
“Millions of people will have lost their health care, many more will have changed their policies,” Schumer said.
The purpose of the House GOP bill seems to be to ease political pressure, giving Republicans something to point to when Democrats blame them ahead of next year’s midterms for higher premiums — or, as Democratic Rep. Jim McGovern of Massachusetts put it: “ass covering.”
Top Republican leaders, for their part, argue that the bill they’re proposing will make health care more flexible and give consumers more options.
“It offers commonsense solutions to lower premium costs for everybody, all Americans,” Speaker Mike Johnson, R-La., said.
But even the more moderate members of the GOP conference aren’t exactly buying that line.
In recent days, vulnerable House Republicans amped up pressure on their leaders to give them a vote on an amendment to extend the subsidies — if not completely, then at least partially.
Over the weekend, Johnson floated the possibility of allowing a vote on an amendment to extend the subsidies. But by Tuesday, amid internal turmoil, that plan fell apart.
A last-ditch effort by those moderates to get a vote on extending those subsidies proved unsuccessful Tuesday evening, when the House Rules Committee blocked four amendments that would have addressed the expiring tax credits.
On Tuesday morning, Rep. Mike Lawler, R-N.Y. — who represents one of three Republican seats Kamala Harris won in 2024 — called not holding a vote on the expiring subsidies “political malpractice.”
Rep. Jeff Van Drew, R-N.J. said that if lawmakers fail to act and premiums go up, “it’s going to hurt Republicans.”
But the question is what GOP advocates for an extension will do now.
There are three live discharge petitions aimed at forcing a vote on the House floor to extend the subsidies for some period of time — though if any of the three get the necessary 218 signatures, the vote likely won’t occur until after the start of the new year.
Two discharge petitions — one spearheaded by Rep. Josh Gottheimer, D-N.J., and another by Rep. Brian Fitzpatrick, R-Pa. — would extend the subsidies for a year and two years, respectively, with new reforms, such as income caps.
Both petitions have generated bipartisan support. But to force a vote, they require an overwhelming majority of Democrats to sign on — and it’s not clear as yet if Democratic leadership will give either their blessing.
Instead, House Democratic leaders continue to push for their own discharge petition. Led by House Democratic Leader Hakeem Jeffries, that discharge petition would force a vote on a bill to extend the subsidies without reforms for three years. That measure is the preferred Democratic vehicle, and it requires just four Republican signatures to hit the magic 218 count needed to force a vote.
At the moment, it’s unclear whether some Republicans — especially those in battleground districts — would be willing to cross party lines and sign the Jeffries proposal. Fitzpatrick, on Tuesday morning, suggested to CNBC that it could happen.
And by Tuesday evening, after the Rules Committee blocked his drive to amend the bill, Fitzpatrick warned, “The only thing worse than a clean extension — without any income limits and any reforms, because it’s not a perfect system — the only thing worse than that would be expiration, and I would make that decision.”
Rep. Kevin Kiley, R-Calif., wouldn’t rule anything out, but he noted that he views the Jeffries proposal “very negatively.”
“Jeffries is insisting that everyone sign on to that one and only one discharge position that has already been rejected by the Senate,” Kiley said, referring to the way a similar three-year extension failed in the upper chamber last week.
“That raises questions about whether he’s actually serious about solving the problem,” Kiley continued.
Van Drew indicated that he would not sign on, arguing that the three-year extension is too long and “really irresponsible” because it doesn’t include reforms.
While things are on tenterhooks in the House, over in the Senate, bipartisan conversations appear to have a new lease on life — at least for the moment.
A bipartisan group of roughly 20 lawmakers met earlier this week, in an effort to find a potential off-ramp to the impasse.
Just last week, senators failed to advance two dueling health care proposals: one, proposed by Democrats, extending the ACA tax credits; the other — a GOP bill — replacing the subsidies with Health Savings Accounts. Both did not overcome the 60-vote filibuster, with the votes falling largely along party lines.
Sen. Susan Collins, R-Maine, who helped spearhead the new talks, called Monday night’s meeting “extraordinarily constructive.”
“When you consider the ideological range of the members who participated, it was very encouraging,” she told MS NOW on Tuesday.
Collins’ bill with Sen. Bernie Moreno, R-Ohio, is being used as a possible baseline for these talks. That plan calls for a two-year “glide path” off the enhanced subsidies, with larger reforms in the second year.
Collins indicated that she hopes to have a proposal formalized later this week — though any vote, if it gets to that point, would probably not come until the new year.
Of course, there are plenty of sticking points that could emerge — notably including abortion.
Democrats have repeatedly argued that any attempt by Republicans to add or expand abortion restrictions as part of any health care deal would be a nonstarter.
It’s a reality Schumer only underlined on Tuesday, when he again invoked 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.
“They still haven’t resolved any of their issues on Hyde,” he said. “This is on the Republicans.”
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