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Congressional Republicans are taking a major political gamble this week, laying out a GOP health care agenda that ignores the soon-to-expire enhanced subsidies that help tens of millions of Americans afford Obamacare — despite pleas from some in their own party.
Top Republicans didn’t come to the decision easily. As recently as last week, it wasn’t clear whether GOP leaders in either chamber would offer their own health care plans alongside a high-profile Democratic push to extend those Covid-era Obamacare subsidies.
There are plenty of frustrated rank-and-file members still trying to convince Republican leaders to change course and offer a short-term fix for the subsidies. Multiple battleground Republicans are plotting how they can intervene, including lobbying President Donald Trump directly or potentially going around their own leadership to force a vote on extending the subsidies, multiple sources told CNN. While they say Obamacare is rife with problems, they insist Republicans can’t simply allow huge premium hikes for millions of people – especially in an election year.
“I support an extension. I don’t want to see us go off this cliff in two and a half weeks. And I support reforms,” said GOP Sen. Lisa Murkowski, minutes after the two parties’ dueling health care proposals failed in the Senate on Thursday.
Rep. Nicole Malliotakis, a centrist from New York, said her next step is to “appeal to the White House.”
“I know, based on his previous comments, that the president is very interested in doing something to address this issue that was a problem Democrats created and was dumped on our laps,” she said. If not, there’s always what she called the “nuclear option” of forcing a vote with help from Democrats by way of a discharge petition.
If the enhanced subsidies lapse, enrollees will see their premium payments more than double — or about $1,000 — on average, according to KFF, a nonpartisan health policy research group. And roughly 2 million more people are expected to be uninsured next year if they lapse, according to the Congressional Budget Office.
But for now, Senate Majority Leader John Thune and his House counterpart, Speaker Mike Johnson, have opted for health care measures that seek to address rising costs without tackling the contentious subsidies. And Trump, for now, is staying out of the fray.
Thune pushed back against criticism from his own party that Republicans will face blowback if the enhanced subsidies expire at the year’s end.
“The Senate is doing what we can to fix this,” he told CNN when asked if the chamber can recess next week for the rest of the year without a solution to address the expiring tax credits.
And he criticized Democratic leaders for reining in their centrist members’ efforts to find a bipartisan path forward: “There are some Democrats who are interested in reforms, but I think what the … Democrat leadership has insisted that whoever wants to do real reforms stand down and, you know, allow them to get this political issue.”
The focus on health care comes as both parties are eager to show voters that they’re tackling rising costs for everyday Americans, with GOP leaders in Congress under intense pressure to show real progress soon. But Republicans on Capitol Hill are limited in what they can do with their slim majorities, and GOP chairs in both chambers are opting to focus on years-old ideas like expanding health savings accounts with broad support in the party.
In the Senate, Republicans on Thursday attempted to pass a bill to expand health savings accounts to help people in certain Obamacare plans afford care. It failed as expected.
The plan, from top GOP chairmen Bill Cassidy and Mike Crapo, would funnel money for two years into health savings accounts for certain lower-income and middle class Americans. The legislation would also resume federal funding of Obamacare’s cost-sharing subsidies, which will help reduce premiums of certain plans.
The chamber also voted on a similarly partisan bill from Democrats, which would fund three more years of Covid-era subsidies, which have allowed low-income Americans to obtain coverage with $0 or near $0 monthly premiums while allowing many middle-class consumers to qualify for aid for the first time. It, too, failed to advance.
Four Republicans backed the effort to advance the Democratic plan: Murkowski, as well as Sens. Susan Collins of Maine, Dan Sullivan of Alaska and Josh Hawley of Missouri.
“What we did today is we demonstrated what we can’t do. We can’t do the Democrats’ straight three-year proposal and we can’t do the Cassidy-Crapo proposal as it stands,” Murkowski said after the vote.
Hawley said he, too, agreed to support both parties’ efforts because lawmakers must do something to address the health care crisis.
“I just think at some point we’ve got to get going here and I’m in favor of doing everything possible to get health care costs down. I mean they are just too high,” Hawley told CNN.
Collins — one of the Senate GOP’s most centrist members — supported the Democratic plan, even though she had expressed some skepticism in recent days of the decision not to include changes to the existing system.
In a statement after the vote, Collins said she wanted to “prevent an unaffordable spike” in premium costs but also wanted to support GOP changes to the program, adding: “It is a broken system that must be fixed — and it cannot be fixed overnight.”
Collins, according to an aide, felt both bills had merit and had components that could be in a final compromise bill.
With support for the proposals falling largely along party lines, it’s a reminder of why Congress is days away from the expiring subsidies with no real solution in sight: No one is in the mood for dealmaking – yet.
For weeks, moderate Republicans and Democrats have insisted that Congress’ only way to avert the premium hikes on December 31 would be taking the leap together. Republicans would need to take their first-ever vote to stand up Obamacare by extending the subsidies, while Democrats would need to acknowledge problems in the system, like skyrocketing costs and some fraud.
Some centrists are hopeful that real bipartisan work can now begin after the Senate’s failed votes on Thursday. But GOP leadership — particularly Johnson — have been so far unwilling to have that fight among their ranks.
“We just can’t get Republican votes on that for lots of reasons,” Johnson said when asked about extending the subsidies.
Johnson was also critical of efforts by moderates in his caucus, including Rep. Brian Fitzpatrick, who formally filed a discharge petition for a bill to extend the ACA subsidies.
“I am not a fan of discharges. It is typically used as a tool against the majority. I understand the concerns that they have, and I’m very sympathetic to that,” he told reporters Wednesday.
Fitzpatrick’s discharge petition is one of two proposals from GOP and Democratic centrists currently circulating among members. Either would need the endorsement of House Minority Leader Hakeem Jeffries to succeed. So far, Jeffries has not weighed in, though he has privately suggested he prefers the bill from GOP Rep. Jen Kiggans of Virginia and Democratic Rep. Josh Gottheimer of New Jersey.
Johnson and his conference reaffirmed Thursday that they are planning their own slate of health care bills for next week, similarly focusing on health savings accounts and cost-sharing reductions.
Some hardliners in the conference – faced with the prospect of a discharge petition – privately expressed openness to a bill to extend subsidies in a closed-door meeting on Wednesday, but there appears to be no consensus on what kind of bill could pass the House in time. (Even Ohio Rep. Jim Jordan suggested House Republicans should act on the subsidies, warning that a discharge petition with Democratic sign off would be a worse alternative, according to two people briefed on his remarks.)
“It’s like nailing jello to a wall with a lot of these members,” said Rep. Ralph Norman, who said he was open to the subsidies for a short period.
“But extend them for how long? That’s always the contentious part,” Norman said.
House and Senate leaders have one tool at their disposal to circumvent Democrats: a partisan gambit known as reconciliation. But Thune said he would prefer a bipartisan compromise that could get 60 votes to overcome a filibuster because the resulting legislation is “more durable.”
Still, Thune said he “wouldn’t rule anything out.”
House GOP leaders, however, are privately bearish on another reconciliation bill this Congress after their Herculean effort to pass Trump’s tax and spending measure this summer. (Trump himself seemed uninterested in another big domestic package on Wednesday, saying, “We don’t need it.”)
Exactly which plans will get a vote in the House is not yet determined. A closed-door meeting of House Republicans on Wednesday ended without a sense of unity on a path forward. House Majority Leader Steve Scalise told reporters the leadership team would spend the coming days finding consensus on a handful of bills to come to the floor next week, likely focusing on health savings accounts and cost-sharing reductions.
But the divergence in opinion across the conference on the subsidies issue was yet another reminder that Trump and his GOP have yet to unify behind a clear health care agenda eight years after the party’s failed attempt to replace Obamacare.
And inside that meeting, multiple endangered lawmakers privately pressed Republican leaders to address the expiring subsidies — but faced sharp pushback from the right flank of their party. One of those members was vulnerable GOP Rep. Kevin Kiley of California, who called on Johnson to put a bill on the floor to extend the tax credits.
If that didn’t happen, he warned, Republicans would face the consequences next November.
“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 the subsidies. So if we go home without addressing that, that is a huge loss,” Kiley said.
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