The Senate is poised on Thursday to reject legislation to extend Affordable Care Act tax credits for millions of Americans, a potentially unceremonious end to a monthslong Democratic effort to prevent the COVID-era subsidies from expiring on Jan. 1.
Despite a bipartisan desire to continue the credits, Republicans and Democrats have never engaged in meaningful or high-level negotiations on a solution. Instead, the Senate is expected to vote on two partisan bills and defeat them both — essentially guaranteeing that many who buy their health insurance on the ACA marketplaces see a steep rise in costs at the beginning of the year.
“It’s too complicated and too difficult to get done in the limited time that we have left,” said Sen. Thom Tillis of North Carolina, who has unsuccessfully pushed his Republican colleagues to extend the tax credits for a short time so they can find agreement on the issue next year.
Neither side has seemed interested in compromise.
Democrats who forced a government shutdown for 43 days on the issue have so far not wavered from their proposal to extend the subsidies for three years with none of the new limits that Republicans have suggested. Republicans are offering their own bill that would let the subsidies expire, even as some in the GOP conference, like Tillis, have said they would support an extension. The GOP proposal would create new health savings accounts to replace the tax credits, an idea that Democrats called “dead on arrival.”
The dueling Senate votes are the latest political messaging exercise in a Congress that has operated almost entirely on partisan terms, as Republicans pushed through a massive tax and spending cuts bill this summer using budget maneuvers that eliminated the need for Democratic votes. They also tweaked Senate rules to push past a Democratic blockade of all of President Donald Trump’s nominees.
A small group of moderate Democratic senators crossed the aisle and made a deal with Republicans to end the shutdown last month, raising some hopes for a health care compromise that quickly faded with a lack of real bipartisan talks.
An intractable issue
The votes were also the latest salvo in the debate over the Affordable Care Act, former President Barack Obama’s signature law that Democrats passed along party lines in 2010 to expand access to insurance coverage.
Republicans have tried unsuccessfully since then to repeal or overhaul the law, arguing that health care is still too expensive. But they have struggled to find an alternative. In the meantime Democrats have made the policy a central political issue in several elections, betting that the millions of people who buy health care on the government marketplaces want to keep their coverage.
“When people’s monthly payments spike next year, they’ll know it was Republicans that made it happen,” Senate Democratic leader Chuck Schumer said in November.
Schumer has also been clear that Democrats will not seek compromise.
Thursday’s vote is “the last train out of the station,” he said. “What we need to do is prevent premiums from skyrocketing, and only our bill does it,” he said.
The health care shutdown
Even if they view it as a political win, the failed votes would be a loss for Democrats who demanded an extension of the benefits as they forced a government shutdown for six weeks in October and November — and for the millions of people facing premium increases on Jan. 1.
While most Democratic senators pushed to keep the shutdown going as Republicans refused to negotiate, a small group of centrist Democrats struck a deal with Majority Leader John Thune for a future health care vote, with no guarantee of success, in exchange for their votes to reopen the government.
Maine Sen. Angus King, an Independent who caucuses with Democrats, said the group tried to negotiate with Republicans after the shutdown ended. But he said the talks became unproductive when Republicans demanded language adding new limits for abortion coverage that were a “red line” for Democrats.
“They’re going to own these increases,” King said of Republicans.
A plethora of plans, but little agreement
Republicans have used the looming expiration of the subsidies to renew their longstanding criticisms of Obamacare and to try, once more, to agree on what should be done. The GOP plan that the Senate will vote on Thursday would replace the tax credits with health savings accounts, an overhaul of the law that they say would put the money in the hands of consumers, not insurance companies that currently receive the current subsidies directly.
Thune announced Tuesday that the GOP conference had decided to vote on the bill led by Louisiana Sen. Bill Cassidy, the chairman of the Senate Health, Labor, Education and Pensions Committee, and Idaho Sen. Mike Crapo, the chairman of the Senate Finance Committee, even as several Republican senators proposed alternate ideas.
In the House, Speaker Mike Johnson, R-La., has promised a vote next week. Republicans weighed different options in a conference meeting on Wednesday, with no apparent consensus.
Moderates in the party who could have competitive reelection bids next year are pushing Johnson to find a way to extend the subsidies. But more conservative members want to see the law overhauled.
Rep. Kevin Kiley, R-Calif., has pushed for a temporary extension, which he said could be an opening to take further steps on health care.
If they fail to act and health care costs go up, the approval rating for Congress “will get even lower,” Kiley said.
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Associated Press writers Kevin Freking and Joey Cappelletti contributed to this report.
