With key Obamacare tax credits set to expire within weeks, Democrats have unified behind a simple message: extend the subsidies and keep health insurance premiums from spiking for more than 20 million Americans.
Republicans, meanwhile, have engaged in a wide-ranging blame game while scrambling to coalesce behind an easily digestible plan to lower health care costs. That struggle comes to a head this week as House leaders move to put what they hope will be a consensus GOP plan up for a vote.
House Republican leaders chose a narrow set of proposals to include in that plan, arguing they lacked broad agreement for a more comprehensive undertaking as they seek to satisfy competing GOP factions, including vulnerable Republicans who’ve argued they will lose their seats if the Affordable Care Act subsidies aren’t extended.
The upshot is that there is no clear, unified GOP message on health care going into the year-end deadline when the tax credits expire — and no guarantee that Republicans will be able to pass anything this week to address the loss of beefed-up subsidies instituted under former President Joe Biden.
“I expect people are going to have an opportunity to vote their conscience and then go defend their votes back home like we always do,” House Budget Chair Jodey Arrington (R-Texas) told reporters about the GOP’s health care strategy.
Across the Capitol, there are already clear signs of unease. While Senate Republicans mostly united behind a plan that would expand health savings accounts as an alternative, four GOP senators crossed party lines to advance a Democratic proposal that would simply extend the Obamacare subsidies for three years.
Now rank-and-file Republicans in both chambers are privately strategizing about how to pull off an unlikely 11th-hour deal to avert a health care price shock that has triggered significant anxiety throughout the party about the political blowback they could face in the 2026 midterms. House GOP moderates negotiated an amendment vote that could tack a subsidy extension onto the leadership-backed health bill, but that vote is expected to fail and only serve as political cover for the vulnerable House Republicans.
That’s because top GOP leaders have resisted scrambling a 15-year-old message their party has been loath to abandon: Obamacare is a costly disaster, and Americans need better options.
“There’s a couple of [issues] that split our conference — that’s one of them,” House Majority Leader Steve Scalise said last week.
The dissonance within the GOP ranks comes as Democrats remain confident their push to preserve the status quo will resonate with voters — especially after making it a central focus of the shutdown fight that ended last month.
Party leaders have managed to keep Democrats largely unified behind a three-year extension of the expiring subsidies. Every Senate Democrat voted to advance that proposal Thursday. In the House, Minority Leader Hakeem Jeffries has managed so far to keep the vast majority of his members from endorsing compromise extension proposals that purple-district Republicans have introduced.
“Our message is simple: Republicans have created a health care crisis for American families who are seeing their health insurance rise by 100 to 300 percent, and the solution has been in front of us for a while,” said Rep. Brad Schneider (D-Ill.), chair of the centrist New Democrats.
President Donald Trump, the GOP’s master of viral messaging, has not been especially helpful when it comes to health care. Trump has repeatedly referred to Obamacare as a “disaster” and railed against insurance companies who collect the federal subsidies — echoing a favorite conservative talking point.
But he has yet to lay out a specific alternative beyond giving “money to the people” directly to buy health care. Trump gave a nod to the issue during the annual Congressional Ball at the White House Thursday, addressing “Democrats” in the room: “We’re going to start working together on health care. I really predict that.”
While some of the Republicans present took the comments to mean Trump might be open to striking a so-far elusive health care deal in January, many Democrats doubt he will be willing to come to the table and extend a framework he has railed against for a decade. Moreover, the party is preparing to use the issue — and Trump’s refusal to engage — to hammer Republicans in the midterms as they show vulnerability on cost-of-living concerns.
“He doesn’t understand the hell that people are going through as they prepare to pay these hugely high health care costs,” said Sen. Chris Murphy of Connecticut, a member of Senate Democratic leadership.
On Capitol Hill this week, familiar divides are likely to play out as Republicans come to terms with the impending expiration of the subsidies, which will mean a much smaller swath of Americans will be eligible for tax credits. The Congressional Budget Office projects millions will choose to drop their coverage rather than pay higher premiums.
Already concerns about political blowback forced House GOP leaders to backtrack from their initial strategy of simply allowing the Obamacare subsidies to expire. As part of their efforts to pass a package of measures meant to erode insurance regulations enacted in the ACA, “the process will allow” for an amendment vote on extending the subsidies, a Republican leadership aide said Friday.
But that has rankled conservatives who have publicly criticized those Republicans who are supporting an extension, and top party leaders do not expect the amendment will be adopted.
“My Democratic colleagues broke health care, and now they are down here saying we must give more money to insurance companies,” Rep. Chip Roy (R-Texas) said Friday on the House floor, “and any Republican who goes along with that needs to answer for doing the same thing.”
Republicans have health care plans, he added, but “what we don’t have is the backbone and the will power to stand up and deliver.”
Scores of Roy’s colleagues, however, have taken a more nuanced view — that even though they share concerns about the cost of the subsidies and the legacy of Obamacare, they are frustrated their party appears to be confronting the issue only at the last minute with family budgets at stake for thousands of their constituents.
Rep. Dan Meuser (R-Pa.) said last week he wasn’t completely happy with the situation and that Republicans “need to move this along.”
“A lot of people are receiving this health care — they don’t need the rug pulled out from under them,” Meuser said. “Definitely should have been done a ways back, we could say, because of the shutdown. But we’ve got to do everything we can and then do more. “I don’t see how we just leave things in limbo,” he added.