With insurance prices under the Affordable Care Act, also known as Obamacare, set to rise on Jan. 1, Republicans are floating a menu of proposals aimed at addressing the expiring health plan subsidies under the law and the resulting premium increases. But the question is, do Republicans — and Democrats, to an extent — really have an appetite for any of these plans?
“It’s just all about willpower,” Rep. Chip Roy, R-Texas, told reporters this week, insisting that there are “dozens” of ways to fix health care.
“If we’ll sit down and do it, we can do it,” Roy said. “And the American people will be the beneficiaries.”
Others are not as optimistic.
Asked about the state of health care discussions on Capitol Hill, Sen. Josh Hawley, R-Mo., told MS NOW he hadn’t heard “a lot of ideas at all,” adding that the lack of real solutions to rising costs “worries” him.“We need to do something such that premiums don’t skyrocket,” Hawley said. “The clock is ticking.”
The central question of the debate boils down to this: What should Congress do about the expiring enhanced ACA subsidies? When those credits go away at the start of 2026, premiums for Obamacare enrollees are set to rise dramatically, with some people seeing their rates double or even triple.
Some Republicans — particularly more moderate members representing battleground congressional districts — have pushed for simply extending the enhanced subsidies for another year to buy more time to negotiate a permanent solution.
But that approach faces notable Republican resistance.
Many GOP lawmakers say further extending the enhanced tax credits is a nonstarter, arguing that the subsidies have only padded the coffers of insurance companies. Extending the subsidies, these Republicans say, would only serve to prop up Obamacare — a program the GOP repeatedly attempted to repeal.
“In the short term, we cannot simply just throw good money after bad policy,” Sen. Mike Crapo, R-Idaho, said on Wednesday.
“I’m not putting a Band-Aid on something that’s broken,” Sen. Markwayne Mullin, R-Okla., told reporters.
The death blow, though, arguably came on Tuesday, when President Donald Trump appeared to all but rule out extending the subsidies, posting on social media that the only kind of health subsidy he would support would be sending the money to consumers — “WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES.”
It’s only the latest instance of Trump calling for sending money earmarked for health care directly to people rather than to insurance companies, an idea he’s returned to repeatedly in recent weeks.
We want this to be something that actually benefits people, as opposed to becoming just a messaging something for the campaign trail.”
Sen. bill cassidy, r-la.
The president’s interest has fostered some buzz on Capitol Hill about legislative proposals mirroring that approach, such as a plan from Sen. Bill Cassidy, R-La.
Cassidy’s pitch — not yet formally introduced in legislative form — calls for replacing the premium tax credits with prepaid health savings accounts (HSAs), which would not be used to help pay for monthly premiums, but could be used to reduce the cost of health care expenses like co-payments and deductibles, according to CNBC.
“We’ve got to take into account the president’s wishes, because that’s the way our Constitution is set up,” Cassidy said.
“We want this to be something that actually benefits people, as opposed to becoming just a messaging something for the campaign trail,” he added.
But Cassidy’s proposal is far from the only HSA-centric idea.
Sen. Rick Scott, R-Fla., is working on alternative legislation, which he introduced Thursday. But over in the House, Reps. Kat Cammack, R-Fla., and Greg Steube, R-Fla., previously introduced a bill that conceptually resembles the president’s idea. And Politico reports that Republicans on the House Ways and Means Committee have recently been circulating the legislation for review.
Provided the GOP settles on a plan, it will still face the difficult task of passing it on Capitol Hill. And to get through the Senate, the party will need to corral Democratic support to overcome the 60-vote filibuster threshold.
Cassidy has implored Democrats not to dismiss ideas just because they come from a Republican, but Democrats have been adamant that the only real solution to the subsidies’ expiration is to extend them — at least until both parties can discuss reforms in a more realistic time frame.
But as a broad concept, most Democrats haven’t outright dismissed the idea of sending money directly to Americans.
“Anytime we’re giving Americans direct support or economic help is almost always better than when we convolute it and make it more complex,” Rep. Pat Ryan, D-N.Y., for instance, told MS NOW.
Yet members of the Democratic coalition have major doubts that sweeping reforms can — or should — be attempted in the next few weeks.
As Sen. Angus King, I-Maine, said of Cassidy’s proposal, “It may be a good idea. Now’s not the time.”
“Let’s take care of this problem that’s going to relieve people from skyrocketing insurance rates, and then we can talk about more comprehensive reform,” King said.
Ryan questioned whether Republicans would actually be able to coalesce around a proposal. “This is a party that’s essentially built their entire decade-plus around trying to rip away health care from tens of millions of Americans,” Ryan said. “They’re totally in the pocket of the health insurance lobby, so I just don’t see any of this working.”
There is, of course, a way to get around the filibuster: reconciliation.
Just this week, a top White House official left open the possibility of using that legislative tool, in effect allowing the GOP to jam a health care plan through the Senate with only a simple majority.
But reconciliation takes time, and there’s a risk that aspects of the GOP plan won’t get through the “Byrd bath,” a process in which the Senate parliamentarian determines whether the bill complies with certain budgetary rules.
Plus, senators don’t seem very excited about trying to address rising health care costs through reconciliation, knowing that leaving Democrats out of the process will open them up to all sorts of political attacks.
“The concern about reconciliation is that it becomes a partisan talking point,” Mullin told reporters on Wednesday. “We’re not opposed to doing it through reconciliation, it’s just 100% partisan at that point.”
Sen. Lisa Murkowski, R-Alaska, told Politico she didn’t want to pursue a GOP-only health care plan. “Let’s be legislators here. Reconciliation is, yes, it’s a tool for us, but it’s a partisan tool, and look at how divided we are right now,” Murkowski said. “That’s not the way to go.”
But time is of the essence.
As part of the shutdown-ending deal crafted earlier this month, Senate Majority Leader John Thune, R-S.D., agreed to give Democrats a vote on a health care bill of their choosing by mid-December. Barring a bipartisan breakthrough, the GOP is expected to offer a counterproposal that will serve as the Republican proposal, and when both bills fail, each party can blame the other for not addressing rising Obamacare costs.
Republicans, however, may have more at stake politically.
Democrats are poised to make the expiring ACA subsidies — and the GOP’s refusal to extend them — a key point in the 2026 midterms.
That strategy would mirror the 2018 midterms during Trump’s first term, when Democrats also made health care a central tenet of their campaign message — and rode that message to a gain of 41 House seats.
“If they don’t extend these tax credits, they own this issue,” Rep. Jim McGovern, D-Mass., said of Republicans.
“We’re going to wrap this around their necks,” he said.
Mychael Schnell contributed to this report.
Kevin Frey is a congressional reporter for MS NOW.