Illustration: Natalie Peeples / Axios
The next big health care showdown in Congress is over the enhanced Affordable Care Act subsidies that expire at the end of the year. And some key Republicans aren't ruling out an extension.
Why it matters: ACA enrollees will sustain major premium increases next year if the subsidies expire, posing a political risk for the GOP after lawmakers voted for health cuts in the tax and spending law.
Driving the news: At this point, GOP leaders in both chambers haven't completely written off the possibility of renewing the subsidies, sources say.
- But it would still face long odds with unified GOP control of the government and a steep price for even a short-term extension.
- "I'm trying to keep an open mind," Sen. Shelley Moore Capito, the No. 4 Senate Republican, told Axios on Tuesday. "We haven't had an extensive discussion. I'll take a look at it. I know it impacts a lot of people in our state."
Between the lines: Attention on the Hill is only just starting to turn to the subsidies, now that reconciliation has passed. There have not been serious negotiations as of yet.
- Backers of the extension are hoping that political pressure will build on moderate Republicans over the coming months. The thinking is that after taking heat for cuts to Medicaid, some in the GOP will look for a way to show that they are taking action to avert more coverage losses.
- Many Republicans still view the subsidies as wasteful spending that benefits insurance companies, however.
- Although GOP resistance to the ACA is not as high as it once was, it's still a tall order for Republican majorities to consider continuing an expansion of the law.
- A key question is whether President Trump will weigh in on the issue. So far, he hasn't.
What they're saying: Rep. Greg Murphy, a Ways and Means member and co-chair of the GOP Doctors Caucus, called the subsidies "basically boondoggles for insurance companies."
- Still, he did not completely slam the door on talks with Democrats over an extension. "There's always room to negotiate, but it's kind of hard to say what was done was right," he said.
- Democrats have a potential point of leverage in government funding talks later this year, given that any plan needs 60 votes in the Senate.
- Senate Finance Ranking Member Ron Wyden told Axios he's going to "pull out all the stops" for an extension but declined to discuss strategy around government funding talks. "I don't want to front-run my colleagues on procedure," he said.
By the numbers: The CBO has previously estimated that an extension would cost $335 billion over 10 years, and that 4.2 million more people would become uninsured if the subsidies are allowed to expire.
- Premiums for remaining ACA marketplace enrollees would increase more than 75% on average, according to KFF.
- A short-term extension is more likely than a 10-year one, but there is still the possibility of GOP demands to offset the cost. Democrats say they will not agree to health care benefit cuts to pay for an extension.
- It is also possible the cost has declined because of the way the tax and spending law is expected to bring down enrollment in the ACA marketplaces. There has been no updated score since passage.
The bottom line: Sen. Thom Tillis has been one of the GOP lawmakers open to an extension, but he said this week it's not going to be easy given the partisan environment.
- "Right now it's definitely shirts and skins mentality," he said.
