GOP considers changing and extending ACA subsidies
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Thune wants to keep big health policy changes out of a stopgap measure to fund the government through November. Photo: Tasos Katopodis/Getty Images
Republican senators are having early discussions about modifying enhanced Affordable Care Act tax credits to allow for an extension of the subsidies before they expire at year's end.
Why it matters: As Congress careens toward a shutdown, the ACA has become a centerpiece of a possible government funding deal and the top ask of congressional Democrats.
Driving the news: GOP leaders insist an ACA extension won't be part of any stopgap legislation to keep the government funded into November.
- But underneath the heated rhetoric that could lead to a shutdown on Oct. 1, there are signs there could be an agreement later this year to extend the assistance that helps about 22 million ACA enrollees afford their premiums.
- Sen. Dan Sullivan (R-Alaska) told Axios conversations on the issue are "going alright" but added the "big [issue] is reform."
- "There is a lot of, whatever you want to call it, fraud," Sullivan said. "And I think everybody acknowledges that, so how do you reform it and still get bipartisan support?"
- Sen. Mike Rounds (R-S.D.) said one modification Republicans have discussed is requiring ACA enrollees to have "skin in the game" by making them pay a minimum premium and barring zero-premium plans that are ACA-compliant but that critics contend fuel fraud.
Another potential change is limiting the tax credits so that enrollees who earn above a certain income level are not eligible. Any extension is also likely to be only for a couple of years, not permanent like Democrats would prefer.
- Sen. Jeanne Shaheen (N.H.), a lead Democrat on the subject, said she has had conversations with Republicans about potential modifications but "it's not clear that there's an inclination on the part of Republican leadership to negotiate around this issue."
What they're saying: Senate Majority Leader John Thune (R-S.D.) left the door open to a subsidy extension on Friday, but said stopgap "continuing resolutions aren't places to load big health policy changes in."
- "We are open to the conversation" about extending the credits, he said, while noting there could be room for "reforms we might be able to make."
The intrigue: Vulnerable Republicans up for reelection next year are particularly concerned about triggering a major premium increase if the credits are not extended.
- Without a resolution, premiums for ACA enrollees will increase over 75% on average if the subsidies expire, according to KFF.
- But conservatives, particularly in the House, remain opposed to an extension they say is costly and contend was intended to be temporary relief during the COVID-19 pandemic.
What's next: Backers of an extension say the clock is ticking and if action is delayed past the Nov. 1 start of open enrollment, some people will log onto healthcare.gov and be scared away by big premium hikes.
- Sen. Lisa Murkowski (R-Alaska) introduced a bill last week to provide for a clean two-year extension of the credits.
- Asked why Democrats are pushing for action on the Sept. 30 bill and not accepting talks later this year, Senate Minority Leader Chuck Schumer (N.Y.) told reporters Friday, "Why not do it now? People are hurting."
