There are only a few short weeks left until Obamacare subsidies expire and enrollees start paying much higher premiums.
Republicans in the House are just starting to have serious discussions about how to address skyrocketing health insurance premiums. They’ll have to move fast to catch up with their Senate counterparts, who are weeks ahead of them in complex and politically contentious deliberations.
After a lengthy recess, House Republicans are together again in person and coming to the drawing board on the policy issue that prolonged the longest government shutdown in history: the enhanced tax credits for Affordable Care Act insurance premiums that are due to expire at the end of the year without congressional action.
They’ll have their first conference-wide conversation Tuesday morning about whether they’ll seek to negotiate an extension with Democrats or forge ahead on a separate conservative health care agenda.
According to two people granted anonymity to share internal party strategy, GOP leadership will lead a high-level discussion in their closed-door meeting focused on how to address rising health care costs, laying out key Republican principles and charting a path forward for putting legislation together under a very tight deadline.
But by their own admission, House Republicans are only in the very nascent stages of negotiations, while Senate Republicans are already outlining detailed proposals to align with President Donald Trump’s vision for lowering the cost of health care by sending health funds “directly to the people.”
It’s causing anxiety in the House GOP ranks among members who don’t want to be forced to swallow whatever plan the Senate comes up with to extend the premium tax credits or some other alternative proposal. The chairs of the critical House committees have plans to hold listening sessions soon to hear members out on their wide-ranging views on health policy. But it’s promising to be a long, deliberative process — and the clock is ticking.
“I don’t want to get jammed by the Senate. We have a lot of smart people in the House,” said Rep. Greg Murphy (R-N.C.), a member of the House Ways and Means Committee. “I’ve been ravenous for [a health care overhaul] literally since the first day I was in Congress, so just working with the three different committees, and hopefully we can do something sooner than later.”
House Republicans have their work cut out for them. Any health care legislation will likely require the input and coordination of three committees: Ways and Means, with jurisdiction over tax policy; Energy and Commerce, which oversees health insurance exchanges; and Education and Workforce, which deals with the insurance rules and standards governing employer health plans.
These committee chairs have been meeting privately and sharing their ideas with House Majority Leader Steve Scalise (R-La.). But the politics are especially tricky to navigate.
Conservatives in the House Freedom Caucus and Republican Study Committee, for instance, have excoriated the enhanced premium tax credits as hand-outs for insurance companies. At the same time, leadership and the committee chairs also have to reckon with a vocal group of GOP moderates who see an extension of the Obamacare subsidies as central to their political survival in next year’s midterms.
In the meantime, any health care package that becomes too ambitious promises to lose votes on either side and crumble apart under its own weight.
“We’re just going to have sessions and figure out what we can get done,” House Energy and Commerce Chair Brett Guthrie (R-Ky.) told reporters Monday. “With December coming up so quickly, there’s some things we can do — hopefully we’ll be able to get done. But the American premiums are demanding their premiums go down.”
The likely deadline for House Republicans to settle up a concrete proposal is the second week of December; that’s when Senate Majority Leader John Thune promised Senate Democrats they would get to vote on legislation that would extend the expiring Obamacare subsidies in exchange for Democratic votes to reopen the government.
Scalise said in a recent interview that “there very well could be” a vote in the House on health care by the end of December but has not committed to following a timeline that gels with the Senate’s.
Mindful of Trump’s call to redirect subsidies from insurance companies directly to enrollees, Ways and Means Republicans are circulating legislation, introduced by Florida Republican Reps. Greg Steube and Kat Cammack, that would fund low-income peoples’ health savings accounts. Cammack said in a brief interview Monday that she had received “a lot of positive feedback” on the bill from the White House.
Meanwhile, Energy and Commerce Republicans are discussing language for a potential modification of the credits that would force enrollees to pay a minimum out of pocket premium — around $5 per year — and other ways to crack down on waste and fraud, according to three people granted anonymity to share their direct knowledge of ongoing conversations.
Ways and Means Chair Jason Smith told reporters Monday he would like to revisit the HSA proposals that the Senate stripped from the House-passed domestic policy megabill earlier this year. That includes provisions that would double the amount that people could put into the tax-advantaged accounts and would allow enrollees in Medicare Part A — which provides hospital insurance — to continue contributing to those accounts as well.
“I think that those are prime for the picking,” the Missouri Republican said of the HSA provisions that didn’t make it into the tax and spending package Trump signed into law.
Smith added he would “absolutely not” support a clean extension of the Obamacare subsidies that GOP moderates have been pushing for alongside almost every congressional Democrat. Instead, he said he wants to look at the 170 million plus people on employer-provided health care that are also facing much higher insurance premiums.
Throughout all this, House Republicans are increasingly feeling the pressure from Senate Republicans who appear to be farther along in developing detailed plans in lieu of a subsidy extension.
HELP Committee Chair Bill Cassidy (R-La.), who also serves on Senate Finance, outlined a proposal to reporters Monday that would directly fund the HSAs of Obamacare enrollees while encouraging people to switch to the so-called bronze ACA plans, which have lower premiums and higher deductibles.
Rep. Mike Flood (R-Neb.), chair of the Main Street Caucus which is stacked with vulnerable GOP incumbents, said he is “very open-minded” about options to drive down health care costs — including Cassidy’s. Flood is also one of more than a dozen Republican co-signers of a bill that would extend the Obamacare subsidies for one year.
Meanwhile, unlike an extension of the subsidies that Republicans could propose to couple with some conservative policy changes — like income caps to determine eligibility — conservatives’ enthusiasm for funding HSA’s as an alternative likely won’t fly with Democrats.
Even if Republicans could unify around such a policy in the House, they need at least eight Democratic votes to advance it in the Senate.
Some House Democrats are desperately trying to engage Republicans in cross-party negotiations. Rep. Brad Schneider (D-Ill.), chair of the centrist New Democrat Coalition, wrote to Flood and Republican Governance Group Chair David Valadao (R-Calif.) outlining a request to meet with members of their respective groups and “find shared solutions to the health care crisis facing our nation.”
But Rep. Sam Liccardo (D-Calif.) wasn’t sure how things would shake out over the course of just a few short weeks. Liccardo is the co-sponsor of a bipartisan bill to extend the Obamacare subsidies but also restrict them to people making up to six times the poverty level. The proposal would be paid for by cracking down on excessive reimbursements paid to insurers.
“A lot depends on what comes from the White House,” Liccardo said in an interview Monday. “We’re a long way off.”