GOP doubles down on ACA subsidy alternatives
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Republicans are taking a harder line against extending enhanced Affordable Care Act subsidies — and doubling down on an alternative plan that would send the money directly to consumers.
Why it matters: President Trump's opposition to an extension makes it increasingly unlikely that Republicans will agree to renew the tax credits, even though it's not clear how the GOP alternative would work or whether the party can reach a consensus.
Driving the news: Trump wrote on Truth Social on Tuesday that the "only" plan he will support is "sending the money directly back to the people," and that Congress should not "waste your time" on anything else, like a subsidy extension.
- Trump didn't elaborate on how his plan would work. The ACA already gives people financial help in buying insurance.
Some GOP proposals envision giving people money for a health savings account on top of existing ACA coverage, mitigating concerns about healthy people leaving the market.
- Senate health committee Chair Bill Cassidy (R-La.) outlined a plan on Monday that would redirect the enhanced subsidy money to an HSA to help pay out-of-pocket costs for people who chose bronze-level ACA plans, which tend to have high deductibles.
- He argued the move would direct money away from insurance companies and to consumers, and empower them to shop for health services.
Another possible outcome would be allowing people to buy cheaper, skimpier coverage that doesn't comply with the ACA's benefit requirements. Some policy experts warn that would destabilize the ACA markets, by prompting an exodus of healthier people.
- That would leave a sicker risk pool and prompt insurers to raise premiums, resulting in a "death spiral," said Larry Levitt, executive vice president for health policy at KFF.
- By contrast, "I don't think there's any risk of, you know, a collapse or death spiral, from what Senator Cassidy is talking about," Levitt said, though without the enhanced subsidies there would still be "potentially millions of people who just won't be able to afford insurance at all."
Between the lines: Senate Majority Leader John Thune (R-S.D.) wouldn't rule out a bipartisan solution when asked about Trump's comments on Tuesday, saying "we'll see" how negotiations go and that "there's an openness" to a deal on the GOP side.
- He said the biggest obstacle, though, could be whether Democrats agree to apply the Hyde Amendment to the subsidies and add restrictions on using the funds for abortions.
The intrigue: Cassidy is framing his plan as the most realistic option, given White House and House GOP leadership resistance to the subsidies.
- "The president is not going to sign a straightforward extension of premium tax credits," Cassidy said. "So if you actually want something which can pass and get a vote on the House floor, then what the president is proposing is actually a better way."
Yes, but: Democrats believe mounting public concern about rising health costs gives them the upper hand pushing for a subsidy extension.
- "Sending people a few thousand dollars while doing nothing to lower health care costs is a scheme to help the ultra-wealthy at the expense of working people with cancer or pre-existing conditions," Senate Democratic Leader Chuck Schumer said in response to Trump's comments.
- "Americans want Congress to extend the ACA tax credits to keep health insurance premiums from skyrocketing on January 1," he added.
The big picture: The war of words is further diminishing the chances that a group of moderates in both parties can find a bipartisan agreement to extend the subsidies with some modifications favored by Republicans, like an income cap and anti-fraud measures.
- House GOP leaders have also been criticizing the subsidies. House Majority Leader Steve Scalise (R-La.) said on Fox News on Sunday that the party would be bringing forward legislation in the coming weeks on other ways to lower costs, like expanding HSAs or cracking down on pharmacy benefit managers.
- The Senate Finance Committee will hold a hearing Wednesday morning on health care costs, giving senators a chance to stake out their positions further in public.
The bottom line: It's unlikely that Trump's plan would gain the necessary 60 Senate votes to advance. But it could give Republican senators political cover if they oppose a subsidy extension.
- Republicans could still opt to use the reconciliation process to pass a bill with a simple majority. Though the White House floated the idea on Tuesday, it's not clear if any GOP-only plan has the votes to pass.
