Americans are being failed by their government.
As it stands, Congress will go home for the holidays without rescuing millions of people whose health insurance premiums will double or more next year. This will mean agonizing dilemmas over already stretched family budgets. Or even decisions not to have any health insurance at all.
A typical day Thursday of congressional dysfunction, blame shifting and an absence of political courage failed to solve the impasse. At the other end of Pennsylvania Avenue, a disinterested president had other things to do.
With Covid-era health insurance subsidies due to expire on December 31, a bitter dispute is unfolding, broadly between Republicans who’ve always hated Obamacare but want to tackle costs and Democrats who are demanding the extension of subsidies but are unwilling to talk about reforms to the law.
This gulf was laid bare when, in classically futile fashion, the Senate voted on two bills that everyone knew would fail to solve the issue.
Republicans put forward a measure to give certain Affordable Care Act policy holders money for two years to put in health savings accounts rather than subsidies to avoid further enriching insurance companies. Trump supports such a plan but has done nothing to make it happen. The problem, however, is there is no guarantee these payments would meet the full costs of health care. Patients might also be left with huge bills in the event of medical emergencies.
Democrats wrote their own bill that would have handed out Covid-era subsidies for another three years. Four Republicans voted with the Democrats, but the bill fell short of the 60 votes needed to pass. The plan would have continued a system that allowed some low-income Americans to get coverage with $0 or near $0 monthly premiums and enabled middle class consumers to qualify for aid for the first time.
The imbroglio has been exacerbated by the continued rise in health care costs, that is not just stalking Obamacare enrollees but also citizens who get their health care through employer plans — and is worsening the affordability crisis shaping the run-up to the midterm elections next year.
Another complication is the GOP’s tiny House majority, which makes it hard to pass any bill on any issue. So is the fact that Democrats are loathe to reform the centerpiece of former President Barack Obama’s legacy. At the same time, the legislation passed in 2010 is reviled in the GOP. This makes it impossible for most Republicans to cast a vote that could be construed in a future primary contest as rescuing Obamacare.
But the political situation is complicated. Millions of Republican voters get their health care through Obamacare policies, so if GOP members don’t act they will be hurting their own supporters.
Moderate GOP lawmakers from swing states are meanwhile leading last-minute efforts to end the health care drama, since they are likely to pay the price first for any voter backlash over the issue.
Democrats, Republicans blame each other
Sometimes in Congress, it takes a period of venting to widen the political space in which a deal can be made. So it’s never over, until it’s over. It’s also frustrating that as is often the case, the potential area of compromise is in clear view — even if it’s impossible for most lawmakers to reach it.
Several Senate bills are floating around still, including one by GOP Sens. Susan Collins and Bernie Moreno that would extend ACA subsidies for two years with some reforms on income gaps and mandated premiums.
Ohio Republican Sen. Jon Husted said Thursday on CNN that he had a measure that would extend subsidies for two years in return for action to fix what he described as fraud in the Obamacare system. “I talked to pastors, small business owners who (are) seeing their premiums skyrocket. I want to intervene and do something about it,” Husted said. “We know that the current system is broken. The ACA doesn’t work. It’s been getting bailed out. I don’t want to continue to bail it out, but I also don’t want people to suffer these premium increases.”
Democrats typically view Republican reform efforts as the latest in a string of attempts over nearly a decade-and-a-half to kill Obamacare entirely or to introduce provisions that would slowly poison it from the inside. There’s some justification for their suspicions since while Republicans are now focused on costs and reforms just before subsidies expire, they’ve not managed to come up with a workable plan to fix health care during multiple presidential administrations and through various periods of congressional control.
If Congress leaves town without fixing the issue, Democrats would have failed to achieve their ostensible goal — getting an extension of subsidies — despite intense efforts to do so, including the triggering of a government shutdown that lasted a record 43 days. A cynic might note that Democrats could have made Obamacare subsidies permanent when they controlled Congress and the White House. And many of their political consultants would relish the chance to attack GOP candidates next year for callousness if the subsidies are allowed to expire.
Next up, Speaker Mike Johnson
The action — such as it is — will return to the House next week.
“Stay tuned. There’s more to come,” House Speaker Mike Johnson told CNN on Thursday evening, promising a plan that will reduce premiums for “all Americans, not just 7% of them.”
But Johnson’s plan seems likely to fall victim to splits in his party over health care and the improbable math in the majority. Conservatives want complete reform of Obamacare and reject any vote to extend subsidies. But some moderate Republicans in swing districts say there is no alternative to extending subsidies because there’s no chance a complex new system could debut by the end of the year.
The last hope for Obamacare policy holders might be several plans by GOP moderates for discharge petitions — a way to force votes against the wishes of party leadership. This was the same method that rebel Republicans used to secure a vote requiring the Justice Department to release the Jeffrey Epstein files. New York Republican Rep. Mike Lawler told CNN’s Jake Tapper Thursday that Democratic House Minority Leader Hakeem Jeffries should release his members to vote for one of the measures so that they could pass.
“The immediacy requires action,” Lawler, one of the most endangered Republicans next year said, but acknowledged both that his own leadership had not allowed a vote on the subsidies and that he needs every Democratic lawmaker to sign up to make the plan work.
“This is a moment to show the American people that Washington can function,” Lawler said.
The well–being of millions of Americans depends on it.
