Scoop: Dems make health deal offer with ACA subsidies

Democrats sent Republicans a proposal over the weekend to renew enhanced Affordable Care Act subsidies for three years, paired with extensions of other expiring health programs, sources said.

Why it matters: Sunday's offer shows there's increasing bipartisan sentiment to address long-stalled priorities like overhauling pharmacy benefit manager business practices — even if prospects for the ACA subsidies are much murkier.

What's inside: The proposal from Democratic leadership and health committees was in response to a GOP offer last week to renew funding for community health centers, certain Medicare telehealth flexibilities and other health "extenders" ahead of a Jan. 30 deadline.

• The underlying package being discussed largely mirrors a bipartisan health deal that was due to be included in a 2024 year-end government funding deal before it was jettisoned at the urging of Elon Musk and then-President-elect Trump, sources said.
• That included PBM measures aimed at lowering drug costs, such as "delinking" PBM compensation from the price of a drug in Medicare Part D.
• There is also a measure addressing Medicare hospital costs that would require hospital outpatient departments to use unique identifier numbers in a bid to crack down on what critics say is overbilling.

Between the lines: Democrats' new offer raised the stakes by adding a politically contentious three-year extension of enhanced ACA subsidies that help people afford premiums.

• GOP leadership is sure to reject inclusion of that in the health care package, but there still appears to be progress on the other elements.
• Democrats' new offer also seeks an increase in funding for programs like community health centers, sources said.

The big picture: On a separate track, a bipartisan Senate group has been discussing an ACA subsidy deal that would extend the tax credits along with new restrictions Republicans favor, such as eliminating $0 premiums that critics say fuel fraud.

• There still are considerable hurdles, with most Republicans still opposed to any kind of ACA subsidy extension and many backing new prohibitions on using the money to pay for abortion services.
• President Trump told reporters Sunday night that he "might" veto a subsidy extension, though he was responding to a question about the clean three-year extension, which is unlikely to get to his desk anyway.