GOP plan leaves ACA subsidies behind
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The outlines of a Senate Republican health care plan are coming into focus, and it wouldn't extend enhanced Affordable Care Act subsidies — increasing the likelihood that the assistance will expire in less than a month.
Why it matters: An expiration would expose millions of Americans to sharp increases in out-of-pocket premium costs that could lead some to go without insurance.
- But Republicans remain divided on this and other alternatives to a straight extension of the ACA tax credits that Democrats are insisting on. It's unclear whether the plan will even get a vote this week.
Driving the news: The plan from Senate Finance Chair Mike Crapo (R-Idaho) and his health committee counterpart Bill Cassidy (R-La.), first reported by Axios, proposes giving certain ACA enrollees $1,000 to $1,500 in a health savings account to help with medical costs, instead of the ACA subsidies.
- That's not the only idea being shopped around. Sens. Bernie Moreno (R-Ohio) and Susan Collins (R-Maine) are proposing to phase out the enhanced subsidies over two years while putting new income limits on eligibility and requiring recipients to make a minimum premium payment to help address fraud.
- Sen. Roger Marshall (R-Kan.) has a plan that would extend the subsidies for one year, then funnel the money into new HSA-like accounts.
Between the lines: Voting on any one of these would likely expose GOP divisions and open the party to charges it doesn't have a solution for an affordability crisis in health care.
- So it's possible that backers of the plans will instead make a range of unanimous consent requests to pass various policy changes, all of which would be blocked by Democrats.
- The Democrats will get their own vote this week on a three-year subsidy extension that's also set to fail in the face of near-unified GOP resistance.
- It's also possible that House Republicans will release a plan or slate of health care bills this week, as Speaker Mike Johnson indicated. One option in that chamber is expanding the use of Association Health Plans, which let employers band together to purchase coverage.
The big picture: The net effect is none of the proposals will likely reach critical mass, and the subsidies will expire at the end of the year.
- But that may not be the end of the story, since the next government funding deadline on Jan. 30 could provide a vehicle for a health compromise.
- Senate Majority Leader John Thune (R-S.D.) told reporters Monday that he thinks some Democrats who want a bipartisan health care deal have been "marginalized" in favor of a "political messaging" vote this week.
Reality check: Any bipartisan compromise on health care faces long odds in an election year.
- Even if the parties can agree on a modified subsidy extension, there are deep divisions over whether to put new limits on use of the funds for abortion coverage.
The bottom line: Many in the GOP are convinced the subsidies are wasteful spending, and that money should go directly to patients instead through HSAs.
- But in a year dominated by talk of affordability, Democrats think they have the upper hand — and contend that simply putting $1,000 or so into an HSA won't help lower- or middle-class people with the massive costs in a health crisis.
