Mike Johnson pledged to unveil a health-care-related package next week, but GOP leaders are being vague about the details.
With only a few weeks to go until lawmakers head home for the holidays, congressional Republicans are still extremely divided on how, or even whether, to advance GOP legislation to address the impending expiration of Obamacare subsidies.
There’s little evidence to suggest that the party can unite behind a clear strategy by December 31, when the enhanced, Covid-era Affordable Care Act credits that were created by Democrats are set to expire.
Republican lawmakers who are eager to address the issue before that deadline are furious at what they describe as a lack of urgency on the part of party leaders to move the ball forward.
House Speaker Mike Johnson (R., La.) has pledged to unveil a health-care-related package next week, but GOP leaders are being vague about the details. It’s unclear what GOP-drafted package Senate Majority Leader John Thune (R., S.D.) plans to put on the Senate floor and when.
Congressional Republicans who are worried about premium hikes are frustrated that party leaders don’t seem to have a clear plan on whether the GOP can advance a legislative package that includes an extension of the enhanced ACA subsidies.
“The real question is: is there a will? And I don’t know,” says Senator Josh Hawley (R., Mo.), who has expressed interest in extending the subsidies with some reforms. “I see that individual members are saying we want to prevent premiums from doubling, tripling, et cetera. But I don’t see a whole lot of urgency out of leadership right now, to be honest with you, and I find that very discouraging.”
Any health-care package that Republicans hope to advance will require buy-in from the president: a lesson the GOP learned again over the summer when Republicans only narrowly passed their sprawling tax bill through the budget reconciliation process. But a getting a bill to President Donald Trump’s desk by the end of the year would require 60 votes in the Senate. And as things stand, the party remains paralyzed over how to proceed.
Some moderate House Republicans are circulating a bipartisan proposal that would temporarily extend the enhanced Obamacare subsidies with modest reforms, with the backing of some House Democrats.
But those subsidies remain extremely unpopular with most congressional Republicans, who say they were meant to be temporary, prop up an inflationary health care system, and are rife with fraud.
Centrist Senator Susan Collins (R., Maine) is reportedly circulating a proposal that would extend the subsidies for two years with a $200,000 income cap while eliminating zero-dollar premium packages, according to Semafor. Senator Rick Scott (R., Fla.), with the backing of the House Republican Study Committee, is advocating a proposal that would create “HSA-style Trump Health Freedom Accounts” to give consumers more choice in their health care decisions.
Confusion surrounding what legislative path Republicans should take has been exacerbated by the fact that Trump — who has spent recent weeks dipping his toes in and out of the debate — has delegated the legislative fight to congressional Republican leaders, who typically rely on him to whip members into line for controversial bills.
Talks continue behind the scenes. White House officials notably spent late last month asking some prominent pro-life groups to hold off on wading into the tense ongoing debate surrounding Obamacare subsidies, preferring instead that the groups keep their worries about insurance companies’ subsidization of elective abortions private as Republicans navigate a path forward on a particularly fractious issue, National Review reported last week.
In Hawley’s view, Republicans have no right to complain that the president is leaving the dealmaking and details up to Congress.
“Last I looked, it was our job to legislate,” he said, adding that Republicans need to move quickly and “give him something he can sign.” But at this point, he added, “if there’s an effort being made by leadership, I’m not aware of it.”
Intra-GOP divisions over how to proceed on health care are emerging as Senate Democrats plan to bring a three-year subsidy extension to the Senate floor next week. Thune promised Democrats a mid-December floor vote as part of the shutdown negotiations.
Ask Republicans about how Democrats are handling the health care debate on Capitol Hill, and they fault the out-of-power party for advancing a clean three-year extension of the subsidies knowing full well that the few Republicans who are even open to extending them in any form desire Hyde protections, income caps, and other legislative changes to any hypothetical language.
“What the Democrats are doing is just trying to make political hay out of it and not be serious about solving the problem,” says Cynthia Lummis (R., Wyo.). “But there’s a real problem. We ought to be talking about real solutions.”
There’s little optimism in Washington that there’s a clear path forward for either party. As one GOP senator put it to National Review earlier this week, Democrats temporarily extended the subsidies through December 2025, and now they expect Republicans to devise “a solution that they’ll never support.”
“If you’re being realistic about it, the Democrats, ultimately, are never going to go for what we want to do,” this senator said, adding the Hyde amendment issue as one of many examples of health-care-related disagreements between both parties. “So, call me kind of bearish on the whole thing.”