Some Senate Republicans are expressing frustration that their conference has been unable to unify behind a health care plan ahead of a vote next week on a Democratic proposal to extend health insurance premium subsidies that expire in January.
Republicans are worried that subsidies, and health insurance and costs in general, could become a major issue in the 2026 midterms, which – in the worst case – could cost the Senate majority.
The GOP lacks consensus on how to proceed on the issue, which could prompt a group of Republican senators to cross the aisle next week and vote for a Democratic bill to expand subsidies under the Affordable Care Act (ACA).
Republicans say they won’t have their alternative proposal to tackle skyrocketing insurance premiums ready in time for a vote next week, leaving some GOP senators frustrated by the lack of a clear strategy to counter the Democrats’ bill.
“I don’t think we’ve come together as a conference around a plan, so no, I’m not satisfied,” said Sen. Lisa Murkowski (R-Alaska). “Hopefully we actually have something we can get 60 [votes] for.”
Senate Health, Education, Labor and Pensions Committee Chairman Bill Cassidy (R-La.) and Senate Finance Committee Chairman Mike Crapo (R-Idaho) led a discussion Tuesday about concepts and proposals that could be part of a Senate GOP health care plan, but senators say it won’t be ready until next week.
Cassidy unveiled a proposal to leave the ACA premium tax credits in place, but to convert the funding for the increased tax credits into contributions to health savings accounts that Americans could use to pay for out-of-pocket health care costs.
But Republican senators say they have not yet seen the text of Cassidy’s plan.
“There really isn’t a difficult proposition,” said Sen. Ron Johnson (R-Wis.).
Sen. Thom Tillis (RN.C.) warned that failure to address rising health insurance premiums will be a political issue in next year’s midterm elections.
“There will be a number of sympathetic cases that Democrats will use in next year’s campaigns,” he told a HuffPost reporter.
Sen. Josh Hawley (R-Mo.) warned that nearly half a million voters in his home state would be affected by the expiration of the increased subsidies.
“I think it’s going to be very painful for a lot of working people,” he said. “They’ll look and say, ‘What are you doing to help me afford health care and get my kids to the doctor?’
“We have to do something about premiums. It’s crunch time, it’s time for the leaders to lock themselves in a room and figure out what to do,” he added. “If they can’t figure out a plan, then maybe, well, you have to do some kind of short-term extension until we figure out a plan.”
A group of centrist Republican and Democratic negotiators worked over the Thanksgiving break to make progress toward a bipartisan deal, but said it won’t be ready in time for next week’s vote either. This is fueling pessimism about any deal being struck this year.
“There are still a lot of conversations going on, but I think it’s going to be difficult to get anything done until next week,” said Sen. Jeanne Shaheen (DN.H.), who played a leading role in the talks.
Shaheen, who has been in touch with House colleagues, said that even if the Senate passes a bill, it’s becoming clear that Speaker Mike Johnson (R-La.) won’t bring it up for a vote.
“What I’m hearing is that President Johnson is unlikely to pass any bill and that it would have to be done through a discharge petition,” she said.
Some want to circumvent the president’s control of Parliament by mustering 218 votes on a discharge petition — a tactic that worked to force a vote on the Epstein Files Transparency Act last month — but that’s a long-shot option that would require weeks or possibly months of effort.
Senate Republicans are split on whether they should even try to rally behind an alternative health care plan. Some Republican lawmakers fear that crafting their own proposal would split their party and give Democrats a target to attack ahead of the 2026 midterms.
Sen. John Cornyn (R-Texas), who is up for re-election next year and faces a tough primary challenge, said Republicans could bring proposals to highlight problems with the Affordable Care Act.
“I don’t see any way we would support expanding the current broken system,” Cornyn told reporters Wednesday, predicting that any bill to expand the ACA’s increased subsidies would fail.
Asked if Republicans might not even offer an alternative plan, Cornyn said, “There are different ideas.”
“Republicans have always had trouble coming together around an alternative health care proposal,” he added. “There is a suggestion to target specific elements of existence [law] to show their problems.”
That would allow GOP candidates in next year’s election to blame the Obama-era law and increased insurance premium subsidies that former President Biden signed into law during the COVID-19 pandemic as major drivers of rising health insurance premiums.
“If you think about what the government has done, everything it’s done has made everything more expensive: cars, health care, housing,” said Sen. Rick Scott (R-Fla.).
Sen. John Hoeven (RN.D.) said he expects Senate Republicans to offer an alternative proposal next week to give fellow Republicans political cover to vote against the Democratic bill to extend expiring prime subsidies.
“They’re probably going to put in place the three-year extension” of the subsidies, he said, adding that “we’re going to put something in as well. I would have expected that at that point you might not pass any of them, and then we’ll go back to work.”
Hoeven said Republicans will highlight their support for more federal funding of health savings accounts that American consumers could use to lower out-of-pocket costs, as well as their support for reforms to the federally managed health insurance marketplaces to require lower-income Americans to pay something for their coverage.
“We recognize that we want to put something in place soon because of the impact of those premium increases right now,” he said.
Senate Democratic Leader Chuck Schumer (NY) has yet to reveal what Democrats will bring next week to help Americans cope with rising health insurance premiums, but Senate Democratic sources predict it will be a three-year extension of ACA subsidies to match a bill backed by Senate Democrats.
Senate Majority Leader John Thune (R.D.) said Wednesday that the Republican plan for how to respond to the Democrats’ subsidy expansion bill will depend on how that proposal is drafted.
Thune said there is broad Republican support for allowing the self-employed and small businesses to participate in “association coverage” and collectively negotiate better health insurance rates or allow them to buy plans offered by Costco and Walmart across state lines.
“Buying across state lines, allowing people to join larger groups — to enter the group market from the individual market … that’s one way you can significantly address the issue of cost and affordability,” he said. “That would be part of everything we do. Obviously some of that would take a little time to implement.”
This story was updated at 6:26 pm
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