Senate Majority Leader John Thune, R-S.D., promised a group of Democratic lawmakers last month that if they voted to end the longest federal shutdown in history, he’d allow a vote on their proposal to extend the Affordable Care Act subsidies that are set to expire. Consequently, a pair of competing bills hits the Senate floor Thursday. Both are doomed to fail, but because health care premiums are set to skyrocket for millions of Americans, the looming failure will likely have Thune and his fellow Republicans feeling like they’re the ones trapped in a corner.
Crafting health care policy isn’t a muscle congressional Republicans have exercised in well over a decade
Senate Democrats put forward a simple bill last week that would extend by three years the cap on premiums for an average plan sold on Obamacare markets. That cap, which ensures that consumers pay no more than 8.5% of their income on such policies, was passed as part of a massive Covid stimulus package in 2021. That provision is due to expire at the end of the year. And if it does, health policy research organization KFF says that in January, the cost of health care for an estimated 22 million Americans will spike by an average of 114 percent.
Thune’s offer to moderate Democrats came with the implicit acknowledgement that no such bill would pass the Republican-controlled Senate. The three-year extension is far beyond what anyone in his caucus will support. All reporting indicates that — until this week, at least — Thune was fine with just having the vote and letting it fail, so he could say he’d kept his end of the bargain. But enough Republicans in the House and Senate are worried about the political fallout of letting the subsidies lapse that they’ve set off on a mad scramble for an alternative plan they can call their own.
But crafting health care policy isn’t a muscle congressional Republicans have exercised in well over a decade. After the ACA passed in 2010, conservatives vowed to “repeal and replace” it. During President Donald Trump’s first term, when (like today) the GOP controlled both chambers of Congress, lawmakers failed at the “repeal” stage. And no credible “ereplace” option has ever materialized despite Trump’s promise during last year’s debate that he has “concepts of a plan.”
You can add Speaker Mike Johnson’s decision to send his caucus home during the 53-day shutdown to the Republicans’ list of unforced errors on health care. He and Thune insisted that any negotiations over the fate of the ACA subsidies could wait. But as MS NOW contributor Paul Waldman has noted, the House GOP’s self-imposed exile from Washington left them little time to come up with proposals to counter the Democrats’ uncomplicated ask.
Senate Republicans, at least, had no problem coming up with ideas. There were anywhere from three to five proposals floating around Capitol Hill earlier this week, with most centered on providing money directly to insurance buyers via health savings accounts, or HSAs. The least bad of the Republican options still isn’t great. The proposal would extend the subsidies for two years but in exchange for new layers of red tape to achieve a similar (but less overall helpful) effect.
But while Democrats are united around their plan, there’s no consensus among Republicans on any one proposal — or that there should be a proposal at all, for that matter. Thune has decided to bring to the floor Thursday a bill by Louisiana’s Bill Cassidy, chair of the Senate Health Education Labor and Pensions Committee, and Idaho’s Mike Crapo, chair of the Senate Finance Committee. Here’s how MS NOW’s Kevin Frey described the Cassidy-Crapo proposal:
According to a summary of the plan, the HSAs would be paired with bronze and catastrophic plans on the Obamacare exchanges in both 2026 and 2027. Eligible individuals between 18 and 49 years old, who make less than 700% of the federal poverty level, would receive $1,000. Those between 50 and 64 years old would receive $1,500.
The legislation would bar HSA funds from being used for abortions or gender transition procedures. And the bill calls for several other health care changes, including a requirement that states check citizenship and immigration status before someone can join Medicaid.
The Cassidy-Crapo bill is a nonstarter for Democrats, leaving the bill nowhere close to the seven Democratic votes that would need to be added to every Republican’s vote to get past the filibuster’s 60-vote threshold. But Thune couldn’t even guarantee Monday that every Republican would vote “yes.” Even if something were to pass the Senate, though, its fate in the House would likely be short-lived.
Speaking of the House, things are somehow faring even worse across the Capitol as Johnson and his leadership team have promised a vote of some kind on health care before the House recesses for the holidays. According to Politico, Johnson presented his caucus on Tuesday with a “list of 10 possible policies that could get votes in the coming weeks or months.” The full list wasn’t exactly encouraging to skeptical members:
Some were more specific, such as an expansion of health savings accounts and an overhaul of pharmaceutical benefit manager oversight. Others were vague, including one bullet point that simply said, ‘Innovation.’ The list did not include an extension of the expiring tax credits.”
The lack of direction from leadership has prompted major frustration among Republicans who represent vulnerable swing districts and are already fretting over a potential shellacking in the midterms. Already, a bipartisan bill that would extend the subsidies for another year has picked up 16 Republican co-sponsors, a sign of how eager those moderate GOP lawmakers are to latch onto a solution.
If House Minority Leader Hakeem Jeffries opted to throw his full caucus’ support behind it, then it would be enough to get the bill to the floor via yet another discharge petition as an end-run around Johnson.
I was among those who criticized the Senate Democrats who broke ranks to accept Thune’s offer. I still believe Thursday’s pending vote does not constitute a victory worthy of the Democrats holding out so long. But, politically, that maneuver did effectively turn the political spotlight onto Republicans, whose leader can’t even admit there’s an affordability crisis and whose lawmakers have no idea what to do about spiraling health care costs.
Hayes Brown is a writer and editor for MS NOW Daily.
