Dems see new health attacks out of shutdown loss

Where it stands: Democrats caved on their demand that Republicans agree to extend the COVID-era enhanced ACA subsidies in order to reopen the government, only getting a commitment for a December Senate vote on some kind of extension.

• But their messaging in the aftermath of last week's elections indicates they're already building a case for blaming Republicans not just for higher ACA costs but for sticker shock in Medicaid and workplace insurance.
• Employer premiums are expected to spike next year, though how much that's tied to GOP policymaking is certainly debatable.
• And looming cuts to state Medicaid programs stemming from the Republican budget law are expected to leave millions more uninsured.

What they're saying: "Trump and the GOP are raising the cost of health care for everyone, including people who are covered through their employers," the Democratic-aligned group Protect Our Care said last week.

• Senate Democrats made similar arguments last week in a letter to the Trump administration, pointing to the way tariffs and a rise in uncompensated care are driving up health costs beyond the ACA market.
• "One of the best ways to play up the affordability issue is to play up out-of-pocket costs," said Democratic strategist Chris Jennings.
• "It would be policy and political malpractice not to do it. They have proof points."

The big picture: This is about more than just the ACA subsidies.

• Democratic strategist Jesse Ferguson said the ACA premium hikes can tie into broader attack lines around the cost of living.
• "Trump and Republicans, they have made life harder and more expensive, driving up costs of everyday goods, driving up costs of health insurance premiums, driving up utility bills," he said.
• "It's not siloed stories. It's one story, with the health insurance bills being tip of the spear."

Between the lines: Even in the unlikely event that Democrats and Republicans cut a year-end deal to narrowly extend the ACA subsidies, messaging on health care costs will feature prominently through the midterm elections.

• And the attack becomes all the more potent if the enhanced subsidies aren't extended.
• "The politics here are not a close call. If voters care about affordability above all, you simply can't risk [control of] the House by letting premiums spike," said Brendan Buck, a spokesperson for advocacy group Keep Americans Covered and a longtime GOP staffer on the Hill.
• "If that happens — paired with the Medicaid cuts — it won't be hard for Democrats, fair or not, to paint all high insurance costs as the fault of the party in power," Buck added.

Reality check: It's a stretch to tie Republicans to employer insurance premium hikes, which aren't directly affected by the expiration of enhanced ACA subsidies and other policies.

• "Because the GOP tax bill does nothing to control health care costs and rips away coverage from millions, premiums are on the rise for the 160 million Americans who rely on employer-based coverage," Protect Our Care argues.
• While Democrats have expanded access to coverage while they were in power, neither party has done much to lower the underlying health care costs driving premium increases in the private market.
• And President Trump will undoubtedly point to his high-profile pricing deals with pharmaceutical companies as evidence he's lowering costs, though how much they will actually lower drug prices is still unclear.

The other side: Trump stepped up his attacks on the ACA subsidies in Truth Social posts over the weekend, saying they benefit insurance companies and proposing that the money instead be sent directly to consumers.

• That call has been embraced by some Senate Republicans, including health committee chair Bill Cassidy, who has proposed funding flexible spending accounts with the money.
• Some vulnerable House Republicans have also called for action on the expiring ACA subsidies, though they say the government should reopen first.
• But most Republicans maintain — both publicly and privately — that the ACA is fundamentally flawed and a major contributor to today's affordability problems.

The bottom line: "The election was about affordability, and that's the takeaway from both Republicans and Democrats," Jennings said.

• "And one of the most visible affordability challenges has been health care costs."