For Republicans, it’s crunch time on ObamaCare.
GOP leaders return to Capitol Hill this week facing a year-end deadline on Affordable Care Act (ACA) subsidies without a unified plan for how — or even whether — to extend the expiring benefits for millions of Americans.
The debate is pitting Republicans concerned with delivering on “affordability” ahead of the 2026 midterms against conservatives who have spent years bashing ObamaCare as a government takeover of the U.S. health care system. Centrist GOP lawmakers facing tough midterm races are fighting to keep the subsidies in place, while other Republicans think the enhanced tax credits — approved by Democrats during the COVID-19 pandemic — should sunset on Jan. 1, as scheduled.
The clash is posing a huge headache for Speaker Mike Johnson (R-La.) and other GOP leaders who have sought to repeal ObamaCare for more than a decade and now face a no-win decision: Either they extend the subsidies, thereby endorsing a law they deem toxic, or they don’t, in which case health care costs will skyrocket for more than 20 million Americans ahead of next year’s midterms.
Some in the party are warning that the House will be lost if they don’t act.
The internal tensions swirling around the issue were on full display last week, when President Trump had reportedly planned to propose a two-year extension of the subsidies along with new eligibility limits — a blueprint designed to get vulnerable Republicans through the elections while party leaders work on a more market-friendly fix.
Instead, the administration scrapped the announcement in the face of a revolt from conservative critics who say the subsidies are just giveaways to insurance companies at taxpayers’ expense.
It was Johnson himself who urged the White House to reconsider, according to The Wall Street Journal.
The pressure campaign delayed any immediate GOP decision on how to proceed, but the respite won’t last long.
Already, some Republicans in the centrist Problem Solvers Caucus have joined forces with Democrats in the group on legislation extending the subsidies for two years. Rep. Jen Kiggans (R-Va.), who’s facing a tough reelection contest, has her own bill promoting a one-year extension — legislation that’s been endorsed by 14 other GOP lawmakers. And the list of proposals is soon to grow as more Republicans race to avoid the coming cost cliff.
Returning from the Thanksgiving break, another group of Problem Solvers Republicans are hoping to introduce yet another plan for extending the tax credits, at least temporarily, setting the stage for a drag-out fight with their conservative colleagues over the fate of the benefits.
Just before the break, those GOP lawmakers huddled for dinner in the basement of Pacci’s, a popular Italian restaurant near Capitol Hill, to work on a plan that can win Republican support, according to Rep. Brian Fitzpatrick (R-Pa.), a co-chair of the Problem Solvers.
“We’re working very aggressively during this off week to hopefully have something [to unveil] when we get back,” Fitzpatrick said.
The ultimate goal is to have the legislation be bipartisan, he emphasized, “but since we’re talking about extending ACA provisions, you’ve got to start with the Republicans, because it’s a Democrat provision.”
Across the Capitol, Senate Majority Leader John Thune (R-S.D.) promised a vote on extending the health care subsidies as a condition of Democrats voting to end the record-setting government shutdown. But there was no promise that the bill would win enough GOP support to pass — or that Johnson would bring a vote in the House.
Complicating the debate further, Trump said last week that he’d “rather not” extend the subsidies and prefers a system of direct cash payments to patients. He acknowledged, however, that “some kind of extension may be necessary.”
While moderate Republicans in swing districts have pushed for extensions of the enhanced subsidies, many of the ideas being floated by Republicans to address health care have centered on completely shifting how money that once funded the subsidies is used.
Sen. Bill Cassidy (R-La.) has pitched using that money from the enhanced subsidies to fund Health Savings Accounts (HSA) for people who buy high-deductible plans, while Sen. Rick Scott (R-Fla.) separately proposed a plan to use the base ObamaCare subsidies to fund “HSA-style Health Freedom Accounts” — amounting to a massive overhaul of the health care law.
Johnson, meanwhile, told The Hill in an interview — days before news of the White House plan leaked — that Republicans “expect to be rolling something out in early December.” House Majority Leader Steve Scalise (R-La.) has been tasked with working with the chairs of the Ways and Means, Education and Workforce, and Energy and Commerce committees to develop a GOP health care plan.
“Our number one objective is to drive down the cost of health care while maintaining quality of care and access to care. And there are many, many different ideas on how to do that, and we’ve not yet built the consensus around which option, but we are very close,” Johnson said.
Some of the red lines for conservatives, though, could be insurmountable for Democrats. Many members, including the Speaker, are prioritizing reforms to ObamaCare subsidies including a Hyde Amendment-like provision restricting the funds from being used on insurance plans that cover abortion services.
The dust-up between the White House and congressional Republicans prompted the leader of one House GOP caucus to assert support for the president’s efforts.
Rep. Mike Flood (R-Neb.), chair of the Republican Main Street Caucus, which describes itself as a group of “pragmatic” conservatives, issued a statement on Tuesday saying that the caucus “supports President Trump’s ongoing efforts to address the ACA tax credit cliff with an extension.”
While Flood stipulated that any solution “needs to include income caps and make serious reforms to the credits,” he stressed that the caucus is committed to finding “a solution that can pass Congress before the end of the year.”
That came in stark contrast to other Republicans in the GOP who have plainly opposed extending the tax credits. The steering committee for the Republican Study Committee, the largest conservative caucus in the House, previously said that Congress “should reject any extension of the wasteful COVID-era subsidies that fuel fraud and drive up costs.”
Democratic leaders, meanwhile, are pushing a discharge petition on their legislation to extend the current subsidies at existing levels for another three years, which would put the next expiration deadline just beyond the 2028 presidential election. That petition, sponsored by House Minority Leader Hakeem Jeffries (D-N.Y.), has been endorsed by virtually every House Democrat, but has no Republican support.
“If House Republican leadership is unwilling to do anything about this issue, all we need are a handful of rank-and-file House Republicans to join us as Democrats, and we can get this done,” Jeffries told CNN just before Thanksgiving.
As the debate heats up, and the internal angst among Republicans begins to spill into the public, even some conservatives are voicing frustrations that Trump’s two-year extension was snuffed out before any formal discussion on it could occur.
“Look, I don’t like the thing, but at least he’s proposing some changes. And we haven’t done anything in, what? Fifteen years?” Rep. Tim Burchett (R-Tenn.) said after the White House canceled its announcement. “Everybody’s griping and moaning about it, [but] at least Trump has the guts to do something about it.”
“I say we ought to take a look at it.”