Congress appears unlikely to enact any health care law before the year’s end, when enhanced Obamacare premium subsidies expire, though some lawmakers still hold out hope for a compromise.
The prospects were dim after the Senate rejected a Democratic bill to extend the enhanced subsidies for three years without changes and a Republican alternative that would redirect taxpayer dollars to tax-exempt health savings accounts.
“While neither proposal did it all for me, there were increments in both that I support,” Sen. Lisa Murkowski of Alaska said after casting votes to advance both bills. She was one of four Republicans to do so.
Ms. Murkowski said two bipartisan House bills that would temporarily extend the subsidies while incorporating some policy ideas favored by Republicans were encouraging.
The centrist House lawmakers from both parties pushing those bills launched discharge petitions to try to force a vote on one or both, but that requires signatures from a majority of the House, 218 members, to succeed. Neither had more than 35 as of Thursday evening.
The Senate has an even higher hurdle to meet. Test votes Thursday on the Democratic and Republican bills each earned a simple majority of 51 votes but fell short of the 60 needed to overcome a filibuster.
“Now with the disposition of these votes, it’s when the work starts,” Sen. Thom Tillis, North Carolina Republican, told The Washington Times. “Hopefully, we pull something out of the hat by next week.”
Next week is the last week Congress is scheduled to be in session for the year, and thus the last opportunity to pass something into law before the pandemic expansion of the Affordable Care Act premium tax credits expires on Dec. 31.
Democrats are not willing to entertain a deal that does not include a temporary extension of the more generous benefits.
The enhanced subsidies cap out-of-pocket premium costs at 0% to 8.5% of household income and extend the benefits to families earning more than 400% of the federal poverty level: $62,600 for an individual and $128,600 for a family of four.
Republicans are largely uninterested in extending the expanded subsidies, and those who are have yet to build large enough coalitions to persuade their leadership to back a compromise plan.
“Republicans have all but guaranteed that tens of millions of people will see their premiums double or triple or more next year,” said Senate Minority Leader Charles E. Schumer, New York Democrat.
He dismissed questions about potential for a bipartisan agreement, saying “there is no compromise” because Senate Majority Leader John Thune, South Dakota Republican, and House Speaker Mike Johnson, Louisiana Republican, oppose an extension of the extra subsidies.
“They’re in their own political bubble,” he said.
Mr. Johnson argues that extending the enhanced subsidies would spend billions of dollars to “merely fuel a system that is ripe with fraud, waste and abuse.” He said the House will vote next week on some Republican ideas to lower health care costs.
Mr. Thune has not ruled out a short-term extension of the subsidies if Democrats are willing to make changes to address Republicans’ concerns.
A handful of Republican senators have proposed plans with income caps at or near $200,000 and minimum premium payments to prevent brokers from enrolling people without their knowledge or consent.
“The question is, do the Democrats, after they got their political messaging vote done, actually want to engage in a real conversation about this, because it didn’t seem like they had a real high level of interest in reforms,” Mr. Thune said. “But there are some who do. I don’t know if there are enough, but I think we’ll get a sense for that here pretty soon.”
He acknowledged that a partisan dispute over whether to include Hyde Amendment language to ensure the subsidies are not used to cover abortions is “a big issue.” Democrats have called it a nonstarter.
President Trump and House Republicans would also need to get on board with any potential deal senators strike, presenting “significant speed bumps,” Mr. Thune said.
Democratic senators say there aren’t enough Republicans who are willing to compromise without Mr. Trump’s approval.
“They care more about pissing off Donald Trump than they do their own constituents,” said Sen. Amy Klobuchar, Minnesota Democrat.
Mr. Trump did not endorse the Senate GOP bill ahead of the vote but briefly commented Thursday evening on Democrats obstructing “a great health care proposal” that stops sending billions to insurance companies and gives money to consumers.
Ms. Murkowski said both bills on which the Senate voted Thursday were “destined to fail,” but lawmakers sometimes have to demonstrate what they can’t do before they get to what they can.
“I want to see an extension to allow people a safe landing and not see this spike and escalation in premiums, and I want to see some reforms,” Ms. Murkowski said.
Rank-and-file senators have had informal discussions for months about what a compromise could look like, but the talks ultimately fell apart, resulting in the two partisan bills.
Sen. Angus King of Maine, an independent who caucuses with the Democrats and was involved in the earlier talks, told The Times after Thursday’s vote that a compromise is still possible.
“We’ll just have to see where the discussions go,” he said.
Sen. Bill Cassidy, Louisiana Republican and chairman of the Senate Health, Education, Labor and Pensions Committee, is one of the authors of the Republican bill. He told The Times that he is open to a deal to temporarily extend the enhanced Obamacare subsidies.
He said Democrats would need to be willing to take action to help families afford their deductibles, such as his bill to provide individuals who purchase high-deductible Obamacare plans with a tax-exempt health savings account of $1,000 to $1,500 per year.
Because the House has bipartisan bills on the table, it may take action sooner if the centrist lawmakers can build support for one or both of the discharge petitions.
They already have enough Republican signatures to succeed if nearly all 213 Democrats join them.
That is unlikely to happen without the blessing of House Minority Leader Hakeem Jeffries, New York Democrat, who is still pushing his party’s discharge petition for a clean three-year extension of the enhanced subsidies.
“All we need are four Republicans to join us,” he said.
He didn’t rule out eventually agreeing to one of the other discharge petitions but said Republicans haven’t demonstrated enough seriousness for Democrats to do that at this stage.
Part of the considerations is political. Most House Republicans supporting the temporary extensions are from swing districts that Democrats aim to flip to win back the House in 2026.
One of the two bipartisan bills extends the enhanced subsidies for one year, which would keep them in place just past the midterms.
“I don’t know why we would consider a one-year [extension] that helps them just get through an election cycle. And that’s all this is about for them,” said Rep. Richard Neal of Massachusetts, the top Democrat on the House Ways and Means Committee with jurisdiction over the Affordable Care Act tax credits. “Republicans are claiming there is bipartisanship. When you compare that to what they had to say about this over the years, you come to a different conclusion.”
