House Republicans are facing significant internal disagreements as they aim to finalize a health care plan before the upcoming holiday recess. The party is under pressure to address rising insurance premiums that are projected to impact millions of Americans in the New Year if Congress fails to extend subsidies for the Affordable Care Act (ACA), which are set to expire on December 31, 2023.
In a bid to satisfy conservative members, House Speaker Mike Johnson of Louisiana and his leadership team are proposing a plan that would not extend the ACA subsidies. Instead, they are considering offering financial assistance to help Americans manage health care costs. This approach has sparked concern among some Republicans, particularly those in competitive districts who argue that any successful health care initiative must gain bipartisan support and extend the subsidies to mitigate the cost burden on constituents.
The urgency for a health care vote stems from the potential backlash Republicans could face in the midterm elections if insurance premiums soar due to a lack of action. Congressman Ralph Norman of South Carolina, a member of the conservative Freedom Caucus, emphasized the need for consensus among party members. “The consensus is we need to come up with something,” he stated following a closed-door meeting discussing health care strategies.
During the meeting, Jim Jordan of Ohio cautioned that Republicans should include some extension of ACA funding along with proposed conservative reforms. Failure to do so, he warned, could lead moderate Republicans to collaborate with Democrats to push a bill through a discharge petition, potentially sidelining the party’s objectives.
Johnson has committed to holding a floor vote on the GOP proposal next week, just before lawmakers depart for a two-week break. Among the ideas discussed were expanding health savings accounts and implementing cost-sharing reductions. Johnson remarked, “We have some low-hanging fruit… things that every Republican agrees to; Democrats won’t. Remember, they don’t actually want to fix this problem.”
In contrast, some Republicans acknowledged that a thorough overhaul of the ACA, a challenge the GOP has grappled with for over 15 years, would require more time and effort. Congressman Dusty Johnson of South Dakota stated, “Health care is unbelievably complicated. You’re not going to reform and bring down costs overnight.”
Fifteen House Republicans, primarily representing swing districts, have signed a bipartisan framework led by Jen Kiggans of Virginia and Josh Gottheimer of New Jersey. This proposal seeks to extend ACA subsidies for two years, albeit with specific adjustments and limitations. Despite this, many Republicans remain opposed to any measures that would support “Obamacare.”
Johnson aligns himself with the majority of his party against extending ACA funding. One Republican member noted that the Speaker is “drawing a line in the sand” regarding the continuation of ACA tax credits. The possibility of a discharge petition, which would require 218 signatures to force a vote, remains uncertain. A coalition of Republicans and Democrats would need to collaborate to make it feasible.
In addition to the Kiggans-Gottheimer framework, centrist Congressman Brian Fitzpatrick of Pennsylvania has proposed an extension of the ACA subsidies with input from the Senate and the White House. His plan aims to extend tax credits for two years while also broadening access to health savings accounts. Fitzpatrick indicated that he might pursue a discharge petition if the leadership does not take decisive action.
While Fitzpatrick’s proposal includes several policies, such as reforming rules surrounding pharmacy benefit managers, it faces challenges in gathering sufficient support. A Democratic aide remarked that some provisions may be impractical to implement in the next year. Congressman Jeff Van Drew of New Jersey stressed the necessity of extending ACA subsidies with reforms to protect vulnerable Republicans and safeguard their majority. He warned against allowing the subsidies to lapse, predicting that it could cost the party vital seats in the upcoming elections.
“If you’re a conservative and you’re a Republican, do you want a Democrat majority next year? I don’t think so. That doesn’t make sense. Let’s not be self-destructive,” Van Drew said.
Even if a bill successfully passes through the House, it still faces the challenge of Senate approval, which is not guaranteed. Additionally, any House vote may not occur until after ACA funding expires, as highlighted by Representative Ted Lieu of California. Lieu criticized Republicans for not prioritizing the discharge petition sooner, underscoring the urgency of extending ACA tax credits to prevent a spike in health care premiums.
As the deadline approaches, the pressure mounts on House Republicans to craft a viable health care plan that addresses both the immediate concerns of their constituents and the long-term objectives of their party. The outcome of this internal struggle could have significant implications for the party’s standing in the midterms.
