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Republicans know they have a health care problem, and they’re divided — both on policy and over whether to cut a bipartisan deal or go it alone.
They’re just not sure what President Donald Trump wants them to do.
The GOP’s potential options range from radically transforming the US health care system to more modest tweaks that extend expiring Affordable Care Act tax credits.
Republican lawmakers think Trump wants them to do something about skyrocketing premiums, the expiring tax credits and health care costs overall, according to interviews with a dozen of them this week. But they’re floundering without more concrete guidance from the president, whose involvement will be required to get any bill through Congress.
“He could veto anything, right? I mean, literally,” said Sen. Roger Marshall, R-Kan., who declined to get into his conversations with the president.
The White House was working last month on a two-year extension of the enhanced subsidies, with changes, but never released it. For now, even as Trump’s aides chastise Democrats for not taking the issue seriously, some Republicans are inclined to work with them.
“At some point in time, the president will have to lean in. But I think it’s too early,” Marshall said. “We’re going to do everything we can to get a bipartisan bill done in January.”
Republicans are parsing everything Trump says about health care in an effort to gauge where he stands, talking to him behind the scenes, and engaging with his advisers. The insurance subsidies expire imminently and could inflame voters by spiking health care costs for millions of people.
One Republican in contact with the president said his aides “want to find a pathway forward,” which is good news for a GOP Congress that needs Trump to litigate intraparty disputes. The House and Senate were at odds over how to execute his tax cuts earlier this year; Trump sided with the House and combined his top priorities in one megabill.
When it comes to moving legislation that splits the party, Trump’s imprimatur is vital this Congress: “Just given the narrow majority, that’s become necessary,” said Rep. Adrian Smith, R-Neb.
Yet without Trump’s direction on health care, the Senate took two failed votes on Thursday and then split for the weekend.
Marshall is among the bevy of Republicans who put out health care proposals in the past week; his approach would extend the subsidies for a year and then transition to a Health Savings Account system.
Sen. Bernie Moreno, R-Ohio, plans to engage the White House about his separate approach, a two-year subsidy extension written with Sen. Susan Collins, R-Maine, that institutes income caps and scraps zero–dollar premium plans.
Their proposal is the most likely one on the table to win over Democrats because it skirts the question of abortion funding; several Democrats told Semafor they’d be open to negotiating with him.
Moreno thinks Trump might even support it.
“Directionally, the president wants to deliver to Americans affordable health care. … I feel comfortable that we’re heading in the right direction,” he said in an interview.
But in a statement, White House spokesperson Kush Desai bashed the ACA subsidies.
“The current system is not working to deliver health care at reasonable prices for everyday Americans. Democrats’ push to maintain these high prices by giving more money to insurance companies is not a real solution for President Trump,” Desai said.
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The group of Republicans willing to support a temporary extension of the subsidies to avoid a massive premium spike may be growing as, in the words of Virginia Democratic Sen. Tim Kaine, “the mixed messages from the White House make it much harder” for them.
“The administration recognizes we need to come up with a solution,” said Sen. Thom Tillis, R-N.C., who has spoken to the president recently about the issue. “We have a lot of good ideas here, and part of what the White House was wanting us to do is see if any of those would coalesce. And they haven’t.”
House Republican leaders are signaling potential votes next week on health care — but likely not on extending the ACA subsidies. Politically vulnerable members are taking matters into their own hands.
“Let’s have a vote, let’s see what gets the most votes here — and then maybe, in that way, the House can actually get in the driver’s seat when it comes to policy again,” said Rep. Kevin Kiley, R-Calif.
Kiley penned a proposal with Rep. Sam Liccardo, D-Calif., to extend the enhanced subsidies for two years and signed discharge petitions from Reps. Brian Fitzpatrick, R-Pa., and Josh Gottheimer, D-N.J., that would force votes on their bills. Both have 11 GOP signatories — meaning either could succeed if the House Democratic caucus puts its weight behind one.
“Our petitions are getting a response, so that’s good,” Fitzpatrick said. “I’m supporting all the petitions — every two-party solution, I will be supporting.”
Congressional Republicans are also floating using reconciliation, the same party-line process they used to pass the tax cuts bill, if they can’t eke out a bipartisan solution.
“The consensus on their side is, they want to save the issue for the midterm elections,” said Sen. John Kennedy, R-La. “If we want to fix health care, we’re going to do it through reconciliation.”
But it’s not clear whether Republicans even have enough momentum for another mammoth party-line package, either on Capitol Hill or at the White House. The failed votes on Thursday didn’t help.
“The fact that the Senate doesn’t appear to have an appetite to extend the ACA subsidies doesn’t give me a lot of hope that we can get it done,” Rep. Mike Flood, R-Neb., who praised Trump’s aborted plan last month, told Semafor. “They don’t have the 60 votes to do it, which is incredibly disappointing.”
Room for Disagreement
Some Democrats worry Trump might try to tank any bipartisan agreement.
“Hopefully Donald Trump doesn’t get involved, just like he did with the Border Protection Act,” said Sen. Jacky Rosen, D-Nev., referring to a border bill Trump helped defeat last year.
“We need to let the Congress do their job,” Rosen added. Some House Republicans expressed a similar sentiment.
“If the president were to weigh in, that would certainly have an impact with some people here, and so it could be helpful — but really, the responsibility I think lies with Congress,” Kiley said. “I don’t think that the right mentality is to say, ‘Let’s just wait for the White House to put its thumb on the scale.’”
Burgess and Eleanor’s View
Trump is not sending a concrete message to congressional Republicans, and at-risk lawmakers in both chambers are scrambling in the vacuum. The tension is building between members of the party seeking an emergency extension of expiring subsidies and conservatives who don’t want to prop up Obamacare.
Trump is perfectly positioned to arbitrate this dispute and potentially take the issue off the table for the rest of his presidency. At the moment, though, he doesn’t see it as a priority. And it seems like nothing will happen until he changes his mind.
Notable
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White House Deputy Chief of Staff James Blair told Semafor on Wednesday night that Democrats’ three-year extension of the subsidies — which got four GOP votes in the Senate — was a sign that the opposing party was not serious about a bipartisan deal.
