What's next after the failed Senate Obamacare votes
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Illustration: Shoshana Gordon/Axios
There's likely to be one more round of health care votes in the House next week after the Senate votes down two rival Affordable Care Act subsidy proposals Thursday — but they won't get any closer to extending the enhanced subsidies.
Why it matters: Those subsidies now appear certain to expire at the end of the year, short of a last-minute breakthrough — and out-of-pocket premium costs will more than double on average for roughly 20 million ACA enrollees.
Driving the news: The Democratic proposal that will get a Senate vote Thursday would extend the enhanced subsidies for three years, while the Senate GOP proposal would not extend the subsidies but instead provide money for health savings accounts.
- Both will fail to get the needed 60 votes.
- Senate Majority Leader John Thune (R-S.D.) has left the door open for further bipartisan talks after both votes fail, but there is deep skepticism in both parties that any such deal is possible.
- Sen. Tim Kaine (D-Va.) said it's possible there is "additional discussion" after the failed votes, but said the issue also might end up in a "political solution in November when people pick the side that's for them."
The latest: House GOP leaders outlined a range of possible health care options on Wednesday morning, but they have little to do with the subsidies, which weren't included in their plans.
- GOP leaders will bring "consensus" bills to the floor next week that aim to lower health care costs, a source who attended House Republicans' Wednesday morning conference meeting told Axios.
- Those could include expanding health savings accounts and association health plans, which allow employers to band together to purchase coverage.
- Overhauling pharmacy benefit managers with the goal of lowering drug costs was also discussed, along with funding ACA payments known as cost-sharing reductions (CSRs).
The intrigue: On the House side, a bipartisan group of moderates including Reps. Brian Fitzpatrick (R-Pa.) and Jared Golden (D-Maine) filed a discharge petition, a procedural move to force a vote on a compromise extension plan.
- But that effort to go around House GOP leadership faces long odds against getting the required majority of the chamber to sign on.
- Modifications to the subsidies in that plan designed to win over GOP votes, like a crackdown on zero premium plans that backers say fuel fraud, could lose Democratic support due to concerns about coverage loss.
Democratic leaders have been focused on a clean three-year extension, saying that is the clearest way to address the issue with little time remaining to implement changes before the new coverage year starts Jan. 1.
- House Democratic Leader Hakeem Jeffries (N.Y.) told reporters Wednesday he has no position on the discharge petition.
The bottom line: There is also deep resistance to a subsidy extension among many Republicans.
- Thune has said he thinks Democratic leadership is more interested in a "political messaging" vote this week than in entertaining reforms to the subsidies that Republicans point to.
- Even if members in either chamber are able to make progress on a consensus compromise subsidy plan, which in theory could be attached to a government funding bill needed before Jan. 30, the divisive issue of abortion hangs over all of the discussions.
- Many Republicans insist on new limits preventing the subsidies from going to insurance plans that cover abortion. Democrats say that is a dangerous expansion of safeguards that already require taxpayer funds to be segregated and not pay for abortion coverage.
