House Republicans are under pressure to finalize a health care plan before their winter recess, but they are struggling to reach a consensus on its contents. With insurance premiums poised to increase significantly as of January 1, 2024, the urgency to extend subsidies for the Affordable Care Act (ACA) remains a contentious topic among party members. These subsidies are set to expire on December 31, 2023, prompting concerns about the potential financial impact on millions of Americans.
House Speaker Mike Johnson, representing Louisiana, is leading a faction of the party that favors a proposal not to extend these subsidies. Instead, the plan would allocate some funds to help Americans manage health care costs. This approach aligns with the more conservative members of the party. Meanwhile, Republicans preparing for competitive midterm elections argue that any health care legislation must include bipartisan support and maintain the subsidies.
The internal conflict reflects broader challenges within the Republican Party as it seeks to navigate rising health insurance costs while protecting its fragile majorities in both the House and Senate. Following a closed-door meeting, Rep. Ralph Norman of South Carolina noted, “The consensus is we need to come up with something.” However, the path forward is fraught with disagreement.
In the same meeting, Rep. Jim Jordan of Ohio cautioned that excluding ACA funding from the Republican plan could lead moderate Republicans to ally with Democrats, potentially derailing the party’s efforts. The looming deadline has intensified pressure on Republicans to act swiftly. Johnson plans to schedule a vote on a GOP proposal next week, just before lawmakers leave for a two-week break.
As discussions unfolded, various ideas emerged, including an expansion of health savings accounts and funding for cost-sharing reductions. Johnson remarked, “We have some low-hanging fruit… We have some things that every Republican agrees to; Democrats won’t. Remember, they don’t actually want to fix this problem.” Yet, other party members recognize that a comprehensive reform of the ACA, which has been a focal point for the GOP for over a decade, requires more time and deliberation.
In a significant move, fifteen House Republicans, primarily from swing districts, endorsed a bipartisan framework proposed by Reps. Jen Kiggans and Josh Gottheimer. This framework seeks to extend ACA subsidies for two years, incorporating some adjustments to funding. However, the majority of Republicans continue to resist any measures that would support the ACA, suggesting a preference for allowing the subsidies to expire.
Johnson is aligning with the majority faction of his party, which opposes extending the ACA tax credits. A Republican lawmaker indicated that Johnson is “drawing a line in the sand” regarding this issue. Despite warnings from Jordan, it remains uncertain whether those advocating for subsidy extensions can successfully utilize a discharge petition to bring their proposals to a vote. Such a petition would require a majority of the House, necessitating bipartisan support.
In addition to the Kiggans-Gottheimer proposal, Rep. Brian Fitzpatrick of Pennsylvania has introduced his own plan to extend ACA subsidies. This proposal, which claims to have input from both the Senate and the White House, aims to extend tax credits for two years while broadening access to health savings accounts. Fitzpatrick has indicated he may pursue a discharge petition to force a vote if leadership fails to act.
However, gathering the necessary 218 signatures for a discharge petition presents a substantial challenge. Some provisions of Fitzpatrick’s plan have been criticized by Democratic leadership aides, who suggest they may be impractical to implement in the upcoming year.
Rep. Jeff Van Drew from New Jersey emphasized the need to extend ACA subsidies with reforms to safeguard vulnerable Republican colleagues and maintain the party’s majority. He warned against the risks of allowing the subsidies to lapse, suggesting that this could jeopardize Republican seats in the midterm elections. “If you’re a conservative and you’re a Republican, do you want a Democrat majority next year? I don’t think so,” Van Drew stated.
Despite the urgency, any proposed health care bill would still need to pass the Senate, which remains uncertain. Even a successful House vote may not occur until after ACA funding has expired, as noted by California Rep. Ted Lieu. Lieu criticized Republicans for not taking the discharge petition process seriously earlier and stressed the necessity of extending the ACA tax credits to prevent health care premiums from soaring.
As House Republicans grapple with these complex issues, the path forward remains unclear, with both internal divisions and external pressures complicating their efforts to address health care in a timely manner.
