The historic government shutdown is over. The fight over health care is just starting.
“This is the beginning of the next round,” Rep. Yvette Clarke, D-N.Y., told MSNBC Wednesday.
And if the government funding battle was bad, the brawl over health care could be even worse.
In exchange for their support of the funding package, eight Senate Democrats received a commitment from Senate Majority Leader John Thune, R-S.D., that he will hold, by mid-December, a vote on a bill of the Democrats’ choosing to extend the expiring Obamacare subsidies.
What that bill will consist of is anyone’s guess. But if Democrats want any chance of passing the legislation, they will need help from at least 13 Republicans to break the 60-vote filibuster.
Lawmakers in both parties have expressed an openness to conversations about the subsidies. But actually extending them won’t be so easy.
At its core, a successful legislative product will require a balance act. To get enough Republicans onboard, Democrats will likely have to offer significant changes to the subsidies. But cut back on the subsidies too much, and Democrats will likely lose votes from their own ranks.
Putting forward a bipartisan bill that doesn’t earn the unanimous support of Democrats just means more GOP votes would be needed to pass it. And actually passing a bill like that risks Democrats losing their one advantage in this fight: the political argument.
Republicans have long campaigned on repealing and replacing Obamacare. And when they’ve tried to follow through on those aspirations, voters have punished Republicans at the ballot box.
Hyde is already part of the federal law. They should go read it.”
So if Democrats were to actually achieve some bipartisan solution to the expiring subsidy problem, they might end up owning the Obamacare premium increases, while also blunting one of their sharpest political tools against the GOP.
The more likely scenario, however, is that lawmakers fail to find any real resolution.
Republicans are demanding major reforms to the subsidies — like income restrictions, reductions to the subsidies, and minimum payments from low-income recipients to ensure that enrollees know they are getting health care. Democrats mostly just want a clean extension.
One of the trickiest issues could be a familiar fault line: abortion.
Since its passage in 2010, the Affordable Care Act has included language mirroring the Hyde Amendment, which prohibits federal funds from being used for abortions except in the case of rape, incest or when the life of the mother is at risk.
Republicans want to go further. They want to add Hyde Amendment language to any subsidy extension.
Twelve states currently have laws mandating that all fully insured plans include coverage for abortion, according to KFF. Additionally, 13 states and Washington, D.C., do not have laws requiring or prohibiting abortion coverage for marketplace plans.
Republicans — including Thune — want to make those restrictions stricter.
Thune told reporters last week that a one-year extension of the subsidies without Hyde Amendment protections “doesn’t even get close.” (Democrats offered a one-year extension of the current policy as a gambit to reopen government.)
Of course, it’s not just Thune who’s raising the abortion provisions as a problem. Sen. Mike Rounds, R-S.D., identified the lack of abortion restrictions as a core problem.
“The fact that we will not fund abortions with this money is gonna be a real issue,” Rounds said. “And I think that they’re gonna say that they disagree, that they’re funding it, and we’re gonna tell them we basically think that you’re just co-mingling funds.”
In doing so, Rounds contended, Democrats were “using taxpayer dollars to fund abortion, and that’s gonna be a problem.”
“That’s got to be resolved,” he added.
Meanwhile, Democrats have forcefully rejected this Republican call for new abortion restrictions in Obamacare. For starters, they believe the effort is moot since Hyde Amendment language has been included in Obamacare since it was signed into law.
“Hyde is already part of the federal law,” House Minority Whip Katherine Clark, D-Mass., said. “They should go read it.”
Beyond that, Democrats are calling the idea of new abortion restrictions a “non-starter.” One Democrat said her GOP colleagues were purposely raising the issue as a poison pill — just trying to make negotiations as difficult as possible.
“Oh, come on,” Rep. Debbie Wasserman Schultz, D-Fla., told MSNBC when asked about some Republicans calling for stricter abortion restrictions. “This is not about abortion; this is about making sure that people’s health care can be affordable.”
“Throwing stuff like that in is not only a non-starter, but it’s just yet another obstacle that they’re creating just to be able to put the likelihood of doing this that much further away,” Wasserman Schultz added.
Beyond the difficulties revolving around crafting legislation that could earn 60 votes in the Senate, there’s no guarantee such a bill would make its way through the rest of Congress — or past President Donald Trump’s desk.
Speaker Mike Johnson, R-La., and his leadership team have been adamant they will not promise Democrats a vote on extending the Obamacare subsidies, even though Thune did.
House Majority Leader Steve Scalise, R-La., who controls what legislation comes to the floor, reiterated that position on Wednesday.
“We don’t have the same kind of commitment in the House,” Scalise noted. “But if you look, we’ve been working on a number of good reforms in the House to lower premiums on families.”
Even if both chambers somehow did clear legislation, Trump could always veto it. The president has railed against Obamacare for years — most recently saying funds should be sent to Americans rather than to insurance companies — leaving lawmakers with another landmine to navigate with the expiring subsidies.
It all leads to Democrats not holding out much hope for an actual solution.
As Rep. Melanie Stansbury, D-N.M., said of Republicans Wednesday: “If we think that they’re actually going to, in good faith, fix the American health care system in the next two months, I think that’s a load of bullshit.”