On Wednesday, House Republicans voted 216-211 to pass a new health-care package that offers a conservative alternative to the ObamaCare subsidies set to expire on Dec. 31, even as the bill leaves the Senate out of reach.
A Conservative Alternative to Expiring Subsidies
The legislation, dubbed the Lower Health Care Premiums for All Americans Act, is packed with measures that are popular among GOP lawmakers. It includes funding for “cost-sharing reductions,” reforms aimed at the pharmacy benefit manager industry, and an expansion of association health plans. Rep. Thomas Massie (R-Ky.) was the sole Republican to vote against the bill.
The GOP’s unity on the bill masks deep divisions within the House conference. Speaker Mike Johnson (R-La.) and his centrist wing have been battling over the fate of the enhanced ObamaCare subsidies for weeks. The disagreement reached a breaking point when negotiations over an amendment that would allow a vote on a plan to extend the subsidies with some reforms collapsed.
The Discharge Petition and the Cost Cliff
In response, four moderate GOP rebels from swing districts crossed the aisle to sign a discharge petition led by Democratic leadership. The petition forces a vote to extend the enhanced subsidies for three years. After the petition was signed, frustrated Republicans blamed Johnson and GOP leaders for giving the rebels no choice.
Rep. Brian Fitzpatrick (R-Pa.) said in a statement, “As I’ve stated many times before, the only policy that is worse than a clean three-year extension without any reforms, is a policy of complete expiration without any bridge. Unfortunately, it is House leadership themselves that have forced this outcome.”
Rep. Mike Lawler (R-Ny.) echoed the sentiment: “I still believe a straight three-year extension is not the right policy, but I fundamentally believe doing nothing is even worse,” he said. “And to me, leadership left us with no option.”
The bill does not address the cost cliff that is expected to hit 22 million Americans when the enhanced Affordable Care Act tax credits sunset on Dec. 31. That dynamic has infuriated centrist Republicans who have been clamoring for months to extend the benefits.
Republican Messaging vs. Democratic Focus
The GOP health-care package was largely a reaction to Democrats pushing the subsidies to the forefront of the debate and demanding negotiations as a condition of ending the government shutdown. While Democrats failed to secure a bipartisan compromise, they succeeded in highlighting rising premiums for ObamaCare enrollees, adding to voter concern about affordability.
Republicans use the bill to counter Democratic messaging, arguing that they are looking for ways to lower premiums across the board, not just for the 22 million Americans who receive enhanced subsidies-who Republicans say amount to just a small percentage of the population.
Rep. August Pfluger (R-Tx), chair of the conservative Republican Study Committee, said, “Democrats are worried about 6 percent of our country. Republicans are worried about 100 percent of our country, and premiums are going up, and not a single Republican has ever voted for ObamaCare.”
Fitzpatrick told reporters on Wednesday that, while the percentage of beneficiaries might be relatively small, the erosion of federal help is significant-especially for those directly affected. “We keep getting this number thrown at us, that it’s only 7 percent of the population. But for that 7 percent, this is everything,” he said. “I know some of those 7 percent, so I don’t even like that narrative.”
Other moderate Republicans accused their own leadership of pursuing a half-baked health-care strategy that was launched too late to ever be effective. Rep. Kevin Kiley (R-Ca.) said, “There’s unfortunately been a lack of leadership on this issue,” adding, “The fact that … the idea just seemed to dawn on leadership to come up with it, like, in December, [and it] doesn’t actually address the crisis that is coming on Dec. 31 – that is frustrating.”
Congress Out of Time
The breakdown of talks over the ObamaCare subsidies means Congress is out of time to prevent out-of-pocket health costs from skyrocketing for millions of people at the start of next year. Lawmakers in both chambers are scheduled to leave Washington for the long holiday break at the end of this week. While the Democrats’ discharge petition will force a vote on the three-year extension, House rules prescribe a waiting period before the bill can be called to the floor-a timeline that is all but certain to push the vote into January.
Republican leaders say the party will continue to work on health-care issues in the new year. Johnson on CNBC on Wednesday said he hopes to advance another reconciliation bill in the first quarter of the new year with more “revisions” to the health-care system.
Sudiksha Kochi contributed.
Key Takeaways
- The GOP passed a health-care package 216-211, but it does not address the cost cliff for 22 million Americans.
- Four moderate Republicans signed a discharge petition to force a vote on a three-year subsidy extension, blaming House leadership for forcing the outcome.
- Republicans emphasize a broad-based premium-cut approach, while Democrats focus on the 6-7 percent of Americans receiving enhanced subsidies.
The bill’s passage underscores deep divisions within the Republican Party and leaves the looming subsidy sunset unresolved as Congress heads into a holiday break.
Closing
With the Senate unlikely to consider the GOP package and the cost cliff looming, the next month will see a clash of proposals that could shape the affordability of health insurance for millions of Americans. The upcoming vote on the three-year subsidy extension will likely take place in January, as lawmakers return from the holiday break.
