Prospects look dim for Congress to agree to an extension of ObamaCare’s enhanced subsidies, as Republicans run headlong toward a December cliff without a clear plan to break their fall.
GOP leaders are trying to coalesce around a unified path on health care, but it’s looking increasingly likely the Affordable Care Act’s (ACA) enhanced subsidies are not going to be part of it.
President Trump told Congress on Tuesday not to “waste your time and energy” on extending the subsidies, and two Republican senators have competing plans they both say deliver exactly what Trump wants.
A growing number of conservative groups and pollsters have been warning Republicans about the political dangers of letting the subsidies expire, and some lawmakers are taking those warnings to heart.
“If we don’t address the subsidies issue in December, I don’t think it’s going to get addressed next year,” Sen. Thom Tillis (R-N.C.) told reporters Thursday. “I see the political shop on the Democrat side just churning up all the very sympathetic stories that are going to result if we don’t come up with a reasonable plan.”
Tillis has called for a one-year extension of the subsidies, while policymakers mull larger reforms to America’s convoluted and expensive health insurance system.
But Trump has made it clear he won’t sign a temporary extension.
Sen. Shelley Moore Capito (R-W.Va.) told reporters that Republicans will eventually work out a health care package among themselves, because she doesn’t see a path forward for a bipartisan compromise.
Asked about a path forward on extending the enhanced subsidies, Sen. Mike Rounds (R-S.D.) said only, “A lot of people doing a lot of work right now.”
But time is running out. Democrats failed to get an extension of the enhanced credits in return for their support to end the government shutdown. Instead, Republicans promised to give them a vote on a bill of their choosing to extend the subsidies.
There are just 12 legislative days until that vote is likely to occur. To pass, the bill would need 13 Republicans to vote for it to reach the Senate threshold of 60 votes. But Republicans can’t agree among themselves on their position.
“We’ve got dozens of ways to fix it,” Rep. Chip Roy (R-Texas) said. “We can have a conversation about what we should do to reform the system, but what we shouldn’t do is continue to put diesel on the fire [by extending the subsidies].”
Without action, an estimated 22 million people in the U.S. will see their health insurance premiums spike when the enhanced subsidies expire Dec. 31.
Those subsidies cost $35 billion per year. Instead of using that money to subsidize premiums, Sen. Bill Cassidy (R-La.) wants to turn it into Health Savings Accounts (HSA) for people who buy high-deductible plans on the ObamaCare exchanges.
Cassidy said his plan aligns perfectly with Trump’s call to send money “directly back to the people.”
If nothing gets done, Cassidy said Democrats will get the blame, not Republicans.
“The president’s there. He wants to do it. So you tell me who’s at fault if something’s not in place for the people in the exchanges. It won’t be Republicans. We got a deal. We got a plan,” Cassidy told reporters.
Republicans generally agree they want to give funds directly to Americans, but they haven’t decided how best to accomplish that.
Sen. Rick Scott (R-Fla.) released his own health care legislation Thursday, separate from Cassidy.
Unlike Cassidy’s plan, which uses the funding from the enhanced subsidies to create HSAs, Scott’s bill creates “HSA-style Trump Health Freedom Accounts” using ObamaCare’s base subsidies — a massive change that could undermine the structure of the health law.
Scott is adamant his plan is what Trump wants.
For Democrats, the only option is to extend the subsidies.
“Donald Trump and Republicans’ ideas about checks and HSAs are nonstarters for Democrats because they are deeply flawed and woefully insufficient for our nation’s health care problems. If Republicans push these flawed policies, they will go nowhere in the Senate,” Senate Minority Leader Chuck Schumer (D-N.Y.) said on the Senate floor.
Cassidy said he is planning a hearing before the Health, Education, Labor and Pensions Committee to discuss his plan when the Senate returns from Thanksgiving recess.
But a similar Senate Finance Committee hearing Wednesday to talk through health ideas devolved into partisan bickering, without any new ideas being presented.
“There is no way for Congress to put together a proposal in the next couple of weeks that’s going to help people in January,” Sen. Ron Wyden (D-Ore.) said.
“If today is a prelude to what’s coming, there will be a lot of people who are going to be on the train tracks” and get hit with massive premiums, Wyden said after the hearing.