Republicans have a mess on their hands over health care subsidies
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Senate Majority Leader John Thune and Speaker Mike Johnson at a news conference at the Capitol on Oct. 10. Photo: Tom Williams/CQ-Roll Call via Getty Images
Senate Majority Leader John Thune and House Speaker Mike Johnson are both considering votes on GOP health care priorities next week — if they can figure out what those priorities are.
Why it matters: Democrats are unified in their demand for a three-year extension of the Affordable Care Act's enhanced subsidies, which expire Dec. 31. Republicans are still divided and debating their counter offers.
- Johnson (R-La.) has said he hopes to reveal a House GOP health care package early next week, though some sources are skeptical that will happen.
- Thune (R-S.D.) has promised Democrats a vote on their health care bill next week. But his conference is still in the idea stage on their counters, which are more likely to come as amendment or unanimous consent votes rather than a single broader GOP package.
Between the lines: Don't expect any health care package to pass next week.
- The real question is whether the voting exercise in the Senate and maybe the House fuels ongoing bipartisan dealmaking — or hampers it.
Zoom in: Sen. Susan Collins (R-Maine) is circulating a plan that would extend the expiring subsidies — but with a $200,000 income cap and no zero-dollar premium packages, Semafor's Burgess Everett reports.
- Sen. Roger Marshall (R-Kansas) told Axios he hopes a GOP package will include moving the expiring subsidies into health care savings accounts and adding his bipartisan bill requiring more price transparency.
- Republicans are also again eyeing changes known as cost-sharing reductions, aimed at lowering premiums, but could cut subsidies for some enrollees.
- Multiple senators described the conversations as broad and fluid, with no real consensus this week on any one, single GOP package. And Hyde protections continue to be a sore spot, with some Republicans demanding increased assurances that subsidies aren't used for abortions.
In the House, Majority Leader Steve Scalise (R-La.) has been holding "listening sessions" with committee leaders and rank-and-file Republicans for weeks to find a consensus GOP plan.
- A bipartisan group of 35 centrist lawmakers , led by Reps. Jen Kiggans (R-Va.) and Josh Gottheimer, unveiled a two-year extension of the ACA subsidies Thursday, but it doesn't have buy in from leadership.
- "We're going to come up with something that I think even people like Jen would support," Scalise said Thursday.
- House GOP leaders have also discussed proposals that would not extend the enhanced subsidies, but instead expand Association Health Plans, where employers band together to purchase health coverage for workers.
House Democrats, meanwhile, filed a discharge petition for a clean three-year extension — the same approach Senate Democrats say they'll put on the floor next week. No Republicans have signed on, and few seem willing to do so.
- Rep. Brian Fitzpatrick (R-Pa.) is also floating a plan that mirrors a White House proposal that was postponed after conservative pushback.
Reality check: A sizable bloc of Republicans in both chambers remain ideologically opposed to extending the subsidies in any form.
- Getting a plan with only GOP buy-in through the House looks nearly impossible — if Johnson chooses to omit an extension of the ACA subsidies in his plan, he'd lose vulnerable Republicans who are fighting to extend them.
- And even if House GOP leadership opted to bring up a bipartisan bill under suspension of the rules, they'd still need to find 80 willing Republicans.
- It will also take time for leadership to familiarize members with the proposal.
The bottom line: With only 10 session days to go, it looks increasingly likely that the health care fight will continue into next year.
