More in GOP open to limited ACA subsidy extension
Illustration: Annelise Capossela / Axios
More congressional Republicans are saying they could support a limited extension of enhanced Affordable Care Act subsidies — but only as part of a wider deal and with possible new limits to the assistance.
Why it matters: Democrats are pushing for a clean extension, but the more realistic path, if there's one at all, is a short-term extension that includes conservative health policies.
What they're saying: "How many clean extensions have you seen of late?" said Sen. Thom Tillis, who began pushing for a subsidy extension in the spring. He added that he didn't know what the contours of a deal could look like.
- Sen. James Lankford, a Finance Committee member, made the tradeoffs explicit when asked if he supported an extension. "I have not taken a position on that, and I think that would be fully an issue of what else is around it," he told Axios.
- "I know that'll be subject to negotiation," said Senate HELP Chair Bill Cassidy. "If the other side wants it, it'll be subject to negotiation, and I'm sure we'll go for something that improves care and lowers costs."
Between the lines: No serious negotiations have occurred yet on the premium subsidies, which are due to expire at year's end. But Senate Republican leaders will need at least some Democrats to come on board for any government funding deal, which could put a subsidy extension in play.
- Changes that could make an extension more palatable for Republicans include limiting the subsidies for higher-income enrollees or requiring that all enrollees pay at least some cost-sharing or premiums.
- Policies like an expansion of individual coverage Health Reimbursement Arrangements could also appeal to GOP lawmakers.
- The subsidies also could be part of a larger health package that could include long-discussed policies of interest to members of both parties, such as an overhaul of PBM business practices.
- Sen. Mike Rounds floated the idea of "additional offsets" that would be bipartisan and help pay for the extension.
Yes, but: Even with possible sweeteners, it is far from clear that a subsidy extension will happen.
- Some Republicans object to the cost, currently projected at over $300 billion for 10 years, or they say the Affordable Care Act has failed.
- "I don't want to renew any part of it," Sen. Ron Johnson told Axios. "I'll be opposing any extension."
- "I think there's better solutions out there," said Sen. Roger Marshall. "The one thing we know about the ACA is it increased the cost of health care."
The bottom line: Democrats are hoping political pressure will convince enough Republicans — along with fear of premium increases in an election year if the subsidies are not renewed.
