Swing-state Republican senators who are up for reelection are scrambling for political cover as the Senate prepares to vote on a Democratic bill to extend health insurance tax credits, even as the GOP struggles to coalesce behind a plan.
Senate Majority Leader John Thune, R-S.D., told reporters Monday that Republicans won’t necessarily put up a GOP health care alternative for a vote on Thursday, when Senate Democrats are due to get a vote on a three-year extension of the Affordable Care Act’s (ACA) tax credits.
“This not a real effort on the part of the Democrats, this is a political messaging effort and the question is when that’s over with, do they really want a solution?” Thune said of the Democrats’ plan.
Thune noted Senate Health, Education, Labor and Pensions Committee Chair Bill Cassidy, R-La., and Senate Finance Committee Chair Mike Crapo, R-Idaho, have circulated a plan to convert federal funding for enhanced subsidies under the ACA into contributions to health savings accounts (HSAs), in order to lower out-of-pocket costs.
The Trump administration has expressed support for contributing federal subsidies to fund health savings accounts, according to Republicans involved in the negotiations.
Thune acknowledged, however, the Senate GOP conference isn’t united on what to do.
“We have people in different camps,” he said.
The Senate GOP leader views the upcoming vote on the Democratic proposal to extend the enhanced insurance subsidies as a political “show vote.” He would prefer to get past it so the Senate can then move to a more substantive bipartisan discussion on health care reform, according to Senate GOP aides familiar with Thune’s position.
But that plan is falling flat with some vulnerable Republican senators who want to vote on a GOP alternative that they can point to when attacked by Democrats for not supporting an extension of the enhanced subsidies, which are due to expire in January.
“We’re having an ongoing discussion. We need a side-by-side. A lot of in-cycle members would like a side-by-side” GOP health care proposal, said a Senate Republican aide familiar with the internal debate.
Maine Sen. Susan Collins, one of the Senate’s most vulnerable Republican incumbents, teamed up Monday with Sen. Bernie Moreno, R-Ohio, to unveil a proposal to extend the enhanced ACA credits for two years and phase out the subsidies for households earning $200,000 or more a year. Their plan would also require a $25-a-month minimum premium payment from lower-income Americans.
The emergence of their plan reflects growing anxiety within the GOP conference that allowing the enhanced subsidies to simply expire in January will cause a political backlash.
Sen. Josh Hawley, R-Mo., is urging Senate GOP leaders to support a short-term extension of the enhanced subsidies to give negotiators more time to craft a longer-term proposal to keep health insurance costs in check.
“If they can’t figure out a plan, then maybe you got to do some kind of short-term extension until we figure out a plan. They should get together here and hammer something out,” he said.
He warned that “sitting back and saying, ‘There’s nothing we can do, we’re just going to let it all expire, we don’t have a substitute, we don’t have an alternative,’ that I think is really a recipe for disaster for people trying to buy health care.”
Hawley didn’t say whether he would vote for the Democrats’ three-year extension of the subsidies, predicting it won’t have enough votes to pass.
Senate Democratic Leader Chuck Schumer (N.Y.) jabbed Republicans over their failure to come up with a health care plan that can unite their party.
“They’re stuck. They can’t get their caucus to agree on a bill,” Schumer told The Hill.
Senate Democratic Whip Dick Durbin, Ill., said that the Moreno-Collins plan to extend the enhanced subsidies for two years could serve as the foundation of a future bipartisan deal, even if it’s unlikely to come together this month.
“I want to sit down with them. I don’t think that’s a bad place to start,” he said. “I’m encouraged by the fact that they want to talk.”
Thune on Monday signaled that Senate Republican leaders may switch strategies and put up a GOP alternative to extend the enhanced subsidies later this week if there’s enough demand among GOP senators.
The Senate Republican Conference will spend more time hashing out their strategy at lunch Tuesday.
The Trump administration is giving GOP senators wide latitude to choose their path forward after the White House in late November circulated a health-policy framework to extend the enhanced insurance premium subsidies for two years and received strong pushback from House Republicans.
The majority of the Senate Republican Conference is strongly opposed to extending the enhanced subsidies, arguing that they are causing inflation within the health care system.
“The problem is ObamaCare is creating runaway medical inflation. People need to understand that. This medical inflation going up is because of ObamaCare,” said Sen. John Hoeven, R-N.D.
He emphasized that Democrats enacted the enhanced insurance subsidies without any Republican support while former President Biden controlled the White House and his party controlled both the Senate and House.
“During the coronavirus, Democrats passed without any Republican votes basically jet fuel in the form of the enhanced [premium tax credit] that just further accelerated that inflation,” he said.
Conservative Sens. Rick Scott, R-Fla., and Mike Lee, R-Utah, meanwhile, have endorsed a plan to allow the enhanced premium tax credits to expire and allow states to submit waivers to the federal government to replace the original ACA tax credits with contributions to “Trump Health Freedom Accounts,” according to an analysis of the plan by KFF, a health policy research organization.
Thune on Monday indicated that Republican leadership prefers the plan circulated among Republican senators Sunday by Cassidy and Crapo.
“I think it represents an approach that actually does something about affordability and lowers costs. And that’s actually well-documented,” Thune told reporters.
“The cost-sharing reductions that are in the Cassidy plan we tried to get done last summer during reconciliation. The Democrats blocked it. It was scored as reducing premiums by 12% and saving $30 billion,” Thune said.
That’s a reference to the proposal that Republicans tried to include in the One Big, Beautiful Bill Act, which Congress passed under special rules known as budget reconciliation last summer.