Chances dwindling for renewal of health care subsidies, risking premium spikes for millions

WASHINGTON (AP) — Hopes for an extension of health care subsidies were diminishing in Congress this week as Republicans and Democrats largely abandoned the idea of bipartisan talks on the issue, increasing the odds that millions of Americans could see sharp premium spikes starting Jan. 1.

Democrats who agreed earlier this month to reopen the government in exchange for a December health care vote were hoping they could work with Republicans to extend the COVID-era Affordable Care Act tax credits that help many Americans pay for their health coverage. But lawmakers in both parties have spent most of the time since talking amongst themselves instead, while rehashing longstanding partisan arguments over the law in public.

“I don’t think at this point we have a clear path forward, I don’t think the Democrats have a clear path forward,” Senate Majority Leader John Thune said Tuesday after Republicans met and discussed different proposals to overhaul the law.

The impasse means the Senate vote, expected next week, could be a party-line messaging exercise with no real chance of passage. Under the deal struck to end the shutdown, Democrats can determine the legislation that comes up for a vote. But Senate Democratic Leader Chuck Schumer has indicated they are leaning toward a vote on a straight extension of the subsidies with no new limits or tweaks to the law, which Republicans have already rejected.

“So far the Republicans are in total disarray and have no plan,” Schumer said Tuesday. “We have a plan.”

Democrats say they are willing to negotiate on the issue, and some have said they would be open to new limits on the subsidies. But they argue that two main issues are holding up talks: the lack of input from President Donald Trump, and Republicans’ insistence that abortion funding be part of the discussion.

“Our Republican colleagues aren’t going to engage with us” unless Trump weighs in, said Sen. Peter Welch, D-Vt. “That’s the paralysis here.”

Abortion issue holds up compromise

Maine Sen. Angus King, an independent who caucuses with the Democrats, was part of the group that struck a deal to end the shutdown. He says there have been some informal bipartisan discussions since then, but says they stalled as Republicans insisted on stricter abortion restrictions on Affordable Care Act plans.

“They have set up a red line that is also a red line for the Democrats,” King said of Republicans. “So they’re going to own these increases.”

Missouri Sen. Josh Hawley, who has said he wants to see the tax credits extended, said the issue “should not be a deal-killer” since a ban on federal funding for abortions is already in the law.

Democrats say current law should be sufficient. While many states ban abortion coverage from all plans in the ACA marketplaces, others allow or require abortion coverage that isn’t paid for with federal funding.

Republicans weigh different plans

Beyond the abortion issue, many Republicans have said for years that they want to see the ACA scrapped or overhauled. But there is still little consensus in the GOP about whether to do that or how.

Republican senators have discussed several competing proposals in recent weeks. Louisiana Sen. Bill Cassidy and Florida Sen. Rick Scott have suggested creating different types of health savings accounts that would change the way people buy insurance — an idea that Trump has endorsed in social media posts without much detail. Other senators have suggested extending the subsidies with new limits on income.

Thune said Tuesday that “we will see where the Republicans come down, but that conversation continues.”

Republicans want to work on a constructive solution, he said, “but that hasn’t landed yet.”

In the House lawmakers were also discussing different ideas. But there was no indication that any of them could be ready by the end of the year or generate enough bipartisan support.

“Health care is a very complicated issue,” House Speaker Mike Johnson, R-La., said Tuesday, while insisting that Republicans were still “pulling ideas together.”

Trump gives little guidance

Lawmakers in both parties have said it will be hard to move forward without Trump’s support for a plan. But the president has yet to formally endorse any legislation.

Last week, the White House circulated a proposal to extend the subsidies with some limits, like new income caps and a requirement that all recipients pay some sort of premium. The proposal would also have allowed those in lower-tier plans, such as the bronze-level or catastrophic plans, to put money into health savings accounts.

But the proposal was never released.

Asked last week whether he wants to extend the subsidies, Trump appeared to refer to the leaked plan, saying that “somebody said I wanted to extend it for two years. … I’d rather not extend them at all.”

Still, he acknowledged that some sort of extension may be “necessary.”

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Associated Press writers Seung Min Kim, Lisa Mascaro and Ali Swenson contributed to this report.