House Republicans are facing significant internal disagreements as they push to finalize a health care plan ahead of the upcoming holiday recess. With a critical deadline looming, insurance premiums are projected to rise for millions of Americans if Congress does not extend subsidies for the Affordable Care Act (ACA) by December 31, 2023.
House Speaker Mike Johnson of Louisiana, responding to pressure from conservative members, is advocating for a proposal that would not extend these subsidies. Instead, it would provide alternative funding options to help offset health care costs for Americans. Conversely, some Republicans, particularly those in competitive districts, are insisting that any health care initiative must include bipartisan support and extend ACA subsidies to mitigate the expected rise in premiums.
The urgency of the situation is palpable, with Republicans under immense pressure to act. They are striving to shield their party from Democratic critiques over health insurance costs and maintain their fragile majorities in both the House and Senate. Representative Ralph Norman of South Carolina, a member of the conservative Freedom Caucus, remarked after a closed-door meeting, “The consensus is we need to come up with something.”
Inside that meeting, Representative Jim Jordan of Ohio cautioned that any viable plan should incorporate some level of ACA funding alongside conservative reforms. He warned that neglecting to include this funding could lead moderates within the GOP to collaborate with Democrats to advance a health care bill through a discharge petition, thereby undermining conservative priorities.
Johnson has announced plans to hold a vote on a Republican health care proposal next week, just before lawmakers depart for a two-week break. Among the ideas discussed were expanding health savings accounts and enhancing funding for cost-sharing reductions. Johnson characterized these proposals as “low-hanging fruit” that all Republicans could support, contrasting them with the Democratic desire to extend ACA subsidies.
Despite these discussions, some Republicans acknowledge that a comprehensive overhaul of the ACA, a challenge the GOP has wrestled with for over 15 years, demands more time and deliberation. Representative Dusty Johnson of South Dakota stated, “Health care is unbelievably complicated. You’re not going to reform and bring down costs overnight.”
A faction of 15 House Republicans, primarily from swing districts, recently endorsed a bipartisan framework proposed by Representatives Jen Kiggans of Virginia and Josh Gottheimer of New Jersey. This framework seeks to extend ACA subsidies for two years, albeit with certain modifications. However, the majority of GOP lawmakers remain resistant to supporting what they term “Obamacare,” preferring to allow the subsidies to lapse.
Johnson appears to be aligning with the prevailing sentiment among most of his members, who oppose extending ACA tax credits. One GOP representative asserted that the Speaker is “drawing a line in the sand” against further funding for ACA subsidies. The path forward remains uncertain, particularly regarding the feasibility of utilizing a discharge petition to bring a health care bill to the floor.
For a discharge petition to succeed, it would require a majority of the House, or 218 members, meaning that some Republicans would need to join with all Democrats. Representative Brian Fitzpatrick of Pennsylvania has introduced his own plan to extend ACA subsidies for two years, emphasizing that it incorporates insights from the Senate and the White House. This proposal, supported by several Democratic representatives, aims to broaden access to health savings accounts alongside the subsidy extension.
Despite the potential for bipartisan cooperation, challenges remain. Some provisions of Fitzpatrick’s bill may face considerable obstacles to implementation next year, as noted by a Democratic leadership aide. Representative Jeff Van Drew of New Jersey underscored the necessity of extending ACA subsidies with reforms, highlighting the risks to vulnerable GOP members and the party’s overall majority.
He warned that allowing the subsidies to lapse could jeopardize Republican seats in the upcoming midterm elections. “If you’re a conservative and you’re a Republican, do you want a Democrat majority next year?” Van Drew questioned, emphasizing the need for a sensible approach to avoid self-destructive outcomes.
Any health care bill that clears the House would still need to navigate the Senate, where its future remains uncertain. Observing the urgency of the situation, Representative Ted Lieu of California criticized Republicans for not addressing the issue sooner, suggesting that procedural hurdles could lead to significant increases in health care premiums if action is delayed.
As the December 31 deadline approaches, the stakes grow higher for House Republicans. The outcome of their deliberations will have far-reaching implications for millions of Americans and the political landscape as they head into the midterm elections.
