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Republicans in the House and Senate are taking wildly divergent paths on health care — setting themselves up for a possible collision.
The House is expected later Wednesday to pass a Senate-crafted deal to end the longest-ever US government shutdown, with support from most Republicans. But one part of that Senate pact doesn’t affect the House GOP: While Senate Majority Leader John Thune has promised a December vote on extending enhanced Affordable Care Act subsidies, Speaker Mike Johnson has made no such vow.
Instead, Johnson reiterated this week that he needs to “build consensus” among his members before moving forward on insurance premiums, which are set to spike for Obamacare participants in 2026 if Congress doesn’t tackle the expiring credits.
His comments further enraged Democrats who are panning the centrist-negotiated Senate agreement as a capitulation. But more importantly, they also signal that an elusive legislative fix for rising health care costs is moving further out of Republicans’ reach.
GOP lawmakers were already bogged down by multiple warring health insurance proposals, each with their own bloc of potential supporters. Now they’re starting parallel debates over whether to seek temporary or permanent changes under two different sets of conditions — which may make whatever proposals they come up with more difficult to reconcile.
Some of their most politically vulnerable members are returning to Washington desperate to keep colleagues in both chambers from losing interest in immediate results.
“Everybody needs to be honest about the problem so that we can actually work in a bipartisan way to fix it — and that obviously needs to be dealt with over the longer-term, which is why I think a short-term extension [of the subsidies] makes sense,” Rep. Mike Lawler, R-N.Y., told Semafor on Tuesday.
“Really, everybody’s got to put their politics aside and actually focus on the problem, which is: Health care is not affordable,” Lawler added.
Agreeing on a solution will be harder for House Republicans than their Senate counterparts — not just because they’ll be juggling other intraparty divides over the Jeffrey Epstein files, lawmaker stock trades, and Syria sanctions with weeks of missed work.
Leaders in the lower chamber have a smaller majority and must also contend with a wider range of opinions, a bigger flock of fiscal hawks, and their members’ more pervasive distrust of Obamacare.
All of the above helps explain why House Republicans are particularly wary of striking any deal before getting more clarity from President Donald Trump, who opined online about alternatives to Obamacare over the weekend. White House deputy chief of staff James Blair on Monday called ACA cost-sharing reduction payments, which the GOP tried to include in its party-line megabill in July, “something we still want to achieve.
“My assumption all along has been: In order to get something through the House, the president has to engage,” Sen. Jeanne Shaheen, the New Hampshire Democrat who negotiated the Senate deal, said. “What we’ve heard is that they’re interested in addressing this issue. He’s the dealmaker; let’s see if he’ll make a deal.”
Both House and Senate Republicans are increasingly torn between two strategies. The first would see the party side with its moderate and blue-state members like Lawler by helping Democrats extend the enhanced subsidies, albeit with key changes — like an income cap, mandatory co-pays and deductibles, or abortion restrictions.
The second would put the party’s weight behind the more time-intensive, partisan pursuit of bigger health care changes. Those could include making the payments Blair mentioned, which some studies have shown would lead to higher premiums, or offering flexible savings accounts to ACA enrollees, which Senate health committee chief Bill Cassidy, R-La., recently floated.
“There needs to be a fix,” Sen. Thom Tillis, R-N.C., said after Finance Committee Republicans huddled Monday to discuss health care.
“If we can’t get bipartisan agreement,” he added, “it may be a valid use for reconciliation.” That’s the grueling legislative process the GOP used to pass its megabill with a simple majority in the Senate.
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Congress enacted the enhanced Obamacare subsidies during the peak of the COVID-19 pandemic. Millions of Americans will see their premiums go up — and potentially choose to forego health insurance as a result — when they lapse at the end of this year.
Democrats and Republicans alike warn those spikes could cost the GOP in the next year’s midterms. But a clean extension of the enhanced subsidies, even for a short period of time, is highly unlikely to become law given the scale of resistance within Trump’s party.
“There needs to be some changes,” Rep. Adrian Smith, R-Neb., said. “Throwing money at this, like the Democrats have tried to do — it’s not working.”
Republicans are still trying to figure out whether they can tweak the enhanced subsidies enough to appease their members while still getting Democratic buy-in — as well as whether it’s possible for them to tackle a bigger health care plan.
A growing number of conservatives are clamoring to pursue the latter.
“These are COVID subsidies Dems are relying on as a Band-Aid on a system they broke,” Rep. Chip Roy, R-Texas, told Semafor. “Congressional Republicans have a plan — we should just have the courage to fight for it.”
If the Senate manages to pass an extension of the enhanced subsidies in December, that would put pressure on the House to take it up the same. But few Republicans see a bipartisan compromise as feasible in mere weeks.
“It’s a complicated issue; it’ll take some time,” Sen. Steve Daines, R-Mont., said.
The White House and Johnson’s office did not return requests for comment.
The View From Democrats
Democrats may be at odds over government funding, but they’re already looking forward to touting Republicans’ disunity over health care.
“Their health care plan for the last 20 years is to not talk about health care,” Rep. Seth Magaziner, D-R.I., told Semafor.
Room for Disagreement
Lawler dismissed the idea that the House and Senate’s disparate timelines could complicate GOP health care talks.
“It happens all the time,” he said. “The Senate and the House have different perspectives; they come to, sometimes, different conclusions; and then you negotiate from there. So it’s not unique.”
Eleanor’s view
Few issues have divided Republicans as long or as consistently as health care — as Trump famously encountered during his first term. Back in 2017, the GOP’s push to dismantle Obamacare imploded in the Senate after 20 House Republicans defected, centrists and conservatives alike.
Even less thorny issues on Capitol Hill don’t seem to be enticing the president these days. So it’s a big question whether he’ll be willing to engage on this one, even as he moves on his own to lower health care costs (including by making weight-loss drugs cheaper).
And navigating a deal without his guidance may well prove impossible.
Notable
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Small business owners will be hit especially hard when the enhanced subsidies lapse, Bloomberg reports.
