Senate heads toward dueling partisan votes on health care, with each likely to fail

WASHINGTON (AP) — The Senate is heading toward dueling partisan votes on health care this week after Republicans said Tuesday that they had united around a plan, for now, that would allow COVID-era health care subsidies to expire.

Both the Republican plan, which would replace the subsidies with new savings accounts, and a Democratic bill to extend the enhanced Affordable Care Act tax credits for three years lack the bipartisan support needed for passage. Senate Majority Leader John Thune, R-S.D., said Tuesday that the Democratic legislation does not include enough reforms to curb fraud or limit high-income recipients. That legislation “will fail,” Thune said.

At the same time, Democratic Leader Chuck Schumer called the Republican plan “phony” and said the bill is “dead on arrival.”

The burden is on Republicans “to vote with us,” Schumer said of Democrats, who forced a 43-day government shutdown over the issue.

With Republicans and Democrats unable to agree — or even really negotiate with each other — increases in their premium payments when the tax credits expire in January. Both sides blame the other for the increasingly likely failure of Congress to act, bringing the issue into the midterm election year with political talking points but little in the way of compromise on the subsidies that have helped keep costs down for many of the more than 24 million Americans.

Tentative GOP unity after years of disagreement

The Republican unity around a single plan, in the Senate at least, comes as the party has wrangled for more than a decade over how to replace former President Barack Obama’s signature law, also known as Obamacare.

The legislation 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, emerged this week from many different proposals from Republican senators, including some that would have extended the tax credits with new limits.

Despite those differences, Republicans worked to project unity as they emerged from a lunch meeting Tuesday. Ohio Sen. Bernie Moreno, who had just recently proposed legislation to extend the subsidies with new income caps, said he is now “hyper-focused” on Cassidy and Crapo’s legislation. Missouri Sen. Josh Hawley, who had his own bill to reduce taxes on health care, said the consensus bill “isn’t perfect, but I’m willing to give it a go.”

“I just think that Republicans can’t do nothing,” Hawley said after the meeting. “I think we ought to be doing everything we can to try and get down the cost of health care.”

Thune said there will now be “something out there that Republicans will be able to talk about and support and vote for, and then we’ll see.”

There was less consensus in the House, where moderate Republicans who are up for reelection have been pushing Speaker Mike Johnson, R-La., to extend the subsidies with new reforms while the right flank of the party has demanded deeper reforms to the ACA. Johnson has not yet said whether there will be a vote on the issue.

Proposed health savings accounts

The bill by Cassidy and Crapo would let the current subsidies, first put in place during the COVID-19 pandemic, expire. The legislation would then make payments to the new health savings accounts for the next two years, for enrollees making less than 700% of the federal poverty level who pick lower-cost, higher-deductible bronze or catastrophic health insurance plans.

Eligible enrollees between the ages of 18 and 49 would get $1,000 per year, while those between 50 and 64 would get $1,500. The money could be spent to defray out-of-pocket expenses like copays and deductibles, or to purchase other qualified health-related items directly from companies, but not to cover monthly premiums.

Cassidy and Crapo say their bill provides better support to Americans than the expiring subsidies do because it hands money directly to the people, giving them the power to decide how to spend or save it — a message President Donald Trump has echoed in recent weeks. Republicans say the plan could also cut down on fraud in the health care system, pointing to a Government Accountability Office report that found some fake recipients were able to get coverage.

The bill also includes new language limiting the use of Affordable Care Act money for abortion — a dealbreaker for moderate Democrats who say they would have been willing to negotiate on the issue.

Uncertainty over costs

Health analysts warn that the plan won’t do much to help lower-income Affordable Care Act enrollees who rely on subsidies to afford their monthly insurance fees.

The Republicans’ plan also requires enrollees to pick higher-deductible plans to be eligible for the payments — meaning heavy users of health insurance may end up saddled with out-of-pocket costs far higher than the new influx of cash in their pockets.

Oregon Sen. Ron Wyden, the top Democrat on the Senate Finance Committee, said the GOP proposal “leaves middle-class Americans saddled with sky-high premiums, and Big Insurance makes out like bandits by selling junk plans to families that desperately need health coverage.”

“Instead of working with Democrats to stop this health cost crisis, Republicans are selling snake oil,” Wyden said.

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Swenson reported from New York.