As of last week, Senate Republicans had no clear plan to address expiring health care subsidies. Now, they’re swimming in plans — they’re just not sure if any can actually pass.
“This is all a bunch of play acting,” Sen. John Kennedy said. “It’s not going to pass, neither is Chuck’s proposal. So we’re back at square one.”
As of Tuesday afternoon, at least five new Republican-led proposals are percolating through the Senate. Sen. Roger Marshall has a plan that would extend subsidies for one year, among other provisions. Sen. Jon Husted is suggesting a two-year extension of the subsidies alongside reforms. Sens. Susan Collins and Bernie Moreno — one of the GOP conference’s most centrist senators and a MAGA acolyte, respectively — are pushing for a two-year extension with different reforms.
Sen. Rick Scott has a plan that would ditch the subsidies and opt for new health care savings accounts instead. And Sens. Bill Cassidy and Mike Crapo are proposing new health care savings accounts for Americans, though in a different way than Scott’s plan.
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The plans may very well keep coming. It’s a scattered showing for a conference that’s been fairly unified this term but has historically struggled to come to a compromise on health care. Now, faced with a vote on Wednesday on a Democrat-led plan that would extend expiring Affordable Care Act subsidies for three years, Republicans are scrambling for a workable alternative.
GOP leaders are narrowing their options. Thune said the Cassidy-Crapo plan will get a vote on Thursday, though it’s unclear whether it will have the votes to pass.
Any health care bill on the floor would require 60 votes, meaning at least seven Democrats would need to vote with all 53 Republicans for legislation to become law, unless it could attract a centrist grab-bag of lawmakers from both parties.
Senate Minority Leader Chuck Schumer said Tuesday the Crapo-Cassidy plan is “dead on arrival.”
“Their bill is junk insurance,” Schumer said. “It’s been repudiated in the past. The American people will repudiate it once again.”
What’s more, some Republicans still seem interested in other options, such as the Moreno-Collins proposal. Thune said Tuesday that moving the Crapo-Cassidy bill forward doesn’t rule out the possibility of other bills advancing.
“I suspect you may see other ideas advanced,” he told reporters. “Whether or not those get voted on, I think is going to be probably up to some of our colleagues who are offering those proposals. But I can tell you, as a conference, our members, and I can’t say 100%, but I think for the most part, I would argue, are united behind the Crapo-Cassidy proposal.”
Democrats seem most amenable to the Collins-Moreno plan, which is the closest legislatively to their own three-year subsidy extension. Senate Democratic Whip Dick Durbin said Monday he was “encouraged” to hear about the Collins-Moreno proposal. While Durbin noted he wanted to make some changes, he said Democrats “ought to be open to ideas.”
Moreno told NOTUS on Tuesday he’s been actively talking with his Democratic colleagues about the plan, and that Democrats “have to decide whether they want a show vote that is about politics or do they want to actually solve a problem.”
Moreno added that he’s not dissuaded by Thune’s apparent preference for the Cassidy-Crapo proposal, insisting “there’s a way to come together for all of us.”
The variety of plans has left some Republicans non-committal. It’s hard to pick a favorite when new choices are emerging every few hours. Sen. Thom Tillis was among them as of Tuesday afternoon, though he said the Collins-Moreno plan seems like a good option to “build on.”
“We got about eight days,” Tillis said of the competing proposals. “That’s tough to harmonize.”
There’s limited time left to find a solution. The Affordable Care Act subsidies in question expire on Dec. 31. After that, health care premiums for recipients will rise dramatically. Congress is slated to leave town after next week, and there are reasonable questions on whether the momentum could or would stay into a New Year.
Sen. Josh Hawley, one of the Republican Party’s most vocal critics on the rising costs of health care, said Monday that he’s “open to just about anything that has a reasonable shot of keeping premiums from doubling.” Hawley also didn’t rule out backing Senate Democrats’ proposal if a GOP alternative isn’t put to a vote.
“Everything is on the table,” he told reporters. “What I’m not going to do is do nothing. I think that is not responsible.”
And Republicans aren’t ruling out some Frankenstein-esque compilation of their proposals. Like Hawley, others said they’re fundamentally for whatever will get the necessary amount of support.
Sen. Markwayne Mullin said Tuesday he would “probably lean towards” the Cassidy-Crapo bill first. But he’s not ruling the others out.
“I’m for whatever we can get the votes on,” he told NOTUS. “So if we’ve got to take a mixture of everything and put it together, I’m OK with that.”
House GOP leaders said they intend to work on health care through next year — continuing after the subsidies have expired and during an election year, when members are often absent and resistant to politically fraught votes.
The Senate’s timeline appears quite different.
“There should be urgency about this,” Hawley told NOTUS. “That doesn’t mean that we should just stop if we can’t reach consensus, but I think we need to have a sense of urgency that isn’t political in nature. It’s human in nature. It’s about the real people who are affected.”
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