When a group of Senate Democrats voted last month to reopen the government — on the promise that they’d get a vote to extend the expiring Obamacare subsidies — they hoped the threat of soaring insurance premiums would force Republicans to act. Now they’re hoping the failure of that vote can reignite negotiations.
On Thursday, dueling health care proposals collapsed in the Senate, all but guaranteeing dramatic premium hikes for people enrolled in plans under the Affordable Care Act once the enhanced subsidies expire on Jan. 1.
In the first vote, a Republican plan to replace the subsidies with direct-to-consumer payments deposited into Health Savings Accounts — $1,000 a year for enrollees age 18 to 49, and $1,500 for enrollees over 50 — failed to clear the 60-vote threshold for cloture, 51-48, with the vote falling largely along party lines. (Sen. Rand Paul of Kentucky was the sole Republican to join Democrats in voting no.)
The GOP proposal also would have included a host of other reforms, including enshrining restrictions on the HSA funds so they can’t be used for abortions.
Minutes later, a Democratic proposal to extend the subsidies for three years also went down, 51-48, with a handful of Republicans bucking party leadership to back the proposal. Sens. Susan Collins of Maine, Josh Hawley of Missouri and Lisa Murkowski and Dan Sullivan of Alaska all voted to support the bill.
Most Republicans argued that the Democratic bill was a nonstarter, particularly because it didn’t include any of the reforms Republicans want, like new income caps. Democrats countered that the GOP plan to address expiring subsidies wouldn’t have actually extended them — and a $1,000 HSA payment wouldn’t come close to covering the premium increases set to hit in January.
The failed votes leave lawmakers with just over two weeks to address the rising premiums. Many enrollees are expected to see their premiums more than double if lawmakers don’t act, and both chambers are scheduled to recess for the holidays at the end of next week.
Some lawmakers are still clinging to the hope that Thursday’s collapse might jolt bipartisan talks back to life.
Ahead of the vote, Senate Majority Leader John Thune, R-S.D., told reporters that if Democrats “want to sit down with members on our side who have an interest in actually solving the problem — and not scoring political points — then I think those conversations can be held.”
But bipartisan talks in recent weeks have gone nowhere. And if they resume, a solution could take weeks — with talks stretching at least into January, after premiums have already surged for millions on the Obamacare exchanges.
By then, Democrats could face a strategic question: engage in bipartisan talks or simply take the political win. Rising health care costs would be a major burden for Republicans heading into the midterms — and Democrats know it. But many in the party say they’re willing to help Republicans avoid that political fallout if it means securing real action on subsidies.
Still, most Republicans remain opposed to extending the subsidies, and both parties are tempering expectations — especially with Democrats only willing to extend the current subsidies and Republicans only willing to embrace sweeping changes.
“There’s no time to try to do major redesign in the American health care system,” Sen. Sheldon Whitehouse, D-R.I., told MS NOW. “I think it’s feasible within a fairly small, substantive scope.”
“People in Connecticut and around the country are desperate,” Sen. Richard Blumenthal, R-Conn., told MS NOW. “We’re in the midst of a health care crisis. So I will go for any kind of compromise that extends the health care subsidy for a period of time that enables people to buy health insurance.”
With Thursday’s failed votes in the Senate, much of the focus now shifts to the House.
House Republican leaders are promising a vote on something next week — though it’s unclear what that will be. Notably, a slide shown in a closed-door meeting with House Republicans on Wednesday included 10 different ideas. None of them was to extend the subsidies. Separately, two moderate lawmakers launched dueling discharge petitions to force floor votes on their own health care proposals, both of which included temporary extensions of the subsidies. One bill — led by Rep. Brian Fitzpatrick, R-Pa. — would extend the tax credits for two years with some new eligibility requirements. Another bill — led by Rep. Josh Gottheimer, D-N.J. — would simply extend the tax credits for one year. Democratic leaders prefer Gottheimer’s approach, and notably, his discharge petition has already attracted enough Republican signatures that, with the entire Democratic Caucus on board, lawmakers could force a vote and pass that measure in the House. That would still leave the Senate, however, where Thune seems resistant to holding another vote if it’s just to extend the subsidies. Looming over these conversations is the one man who could fundamentally change the dynamics: President Donald Trump. Trump has so far mostly stayed out of the discussions, with GOP lawmakers on Capitol Hill promptly shooting down an idea that the White House floated to extend the subsidies with some changes. If Trump were to engage in the discussions, he may want to address the expiring subsidies in some way. For months, Democrats have believed the president is their best chance at meaningful action. And without Trump’s engagement — or at least his blessing — it seems unlikely that much of anything will happen. Ali Vitali, Syedah Asghar and Jack Fitzpatrick contributed to this report.
Kevin Frey is a congressional reporter for MS NOW. Recommended
