Illustration: Maura Losch/Axios
Senate Republicans on Tuesday served notice that they're digging in for a major fight next year over renewing enhanced Affordable Care Act subsidies — one that they say could spotlight major flaws in ACA marketplaces.
Why it matters: Hospitals, insurers and provider and patient groups already are mobilizing for what's shaping up to be a drawn-out debate over the subsidies and the possibility of a grand compromise if there's divided government.
What they're saying: Republicans on the Senate Finance Committee bashed the enhanced subsidies as expensive and wasteful at a hearing today, indicating that it won't be an easy sell to get them to vote to renew the aid, which has largely benefited people in red states.
- "The IRA uses hardworking taxpayer funds to camouflage the ongoing flaws with the individual health insurance market," said Finance Committee Ranking Member Mike Crapo.
- He cited CBO estimates that permanently extending the enhanced subsidies would increase the deficit by more than $325 billion over a decade, plus billions more in interest outlays.
- Theo Merkel, a former Trump administration health official now at Paragon Health Institute, testified that extending the subsidies was a move to "simply paper over the poor quality of the plans themselves."
- And he said enrollment in the ACA is up "through tolerance of substantial fraud."
The big picture: Although Republicans would almost certainly let the subsidies expire if they sweep the election, a deal still could be struck in a divided government to temporarily extend them in exchange for renewing some expiring Trump tax cuts.
- Senate Finance Chair Ron Wyden made clear that the subsidies are a priority, saying he is "all in" on the effort and framing the issue as preventing a "giant premium spike."
Between the lines: As we reported last week, some powerful industry groups, as well as patient advocates, are pushing for the renewal of the subsidies, meaning the effort will be backed by strenuous lobbying.
- The Finance hearing gave Democrats on the panel a chance to preview a new health care line of attack against the Trump-Vance ticket.
- Wyden pointed to comments Sen. JD Vance made on NBC's "Meet the Press" on Sunday calling for sick people to be in a separate risk pool. He said Vance's ideas are "a prescription for going back to the days when you can clobber people with a preexisting condition."
What's next: Crapo did point to one area of bipartisan cooperation, the committee's PBM legislation, which he noted "stands waiting to be passed."
