The shutdown debate over the expiration of expanded ObamaCare subsidies has put health care Republicans on the defensive and reopened ancient wounds from the 2017 attempt to repeal and replace the law.
Fifteen years after the Affordable Care Act’s passage, the scars of repeal efforts and Republicans’ continued antipathy toward the law influence the party’s varied response.
While Republicans are united in criticizing the law and the need for subsidies, there is no clear plan for how to deal with rising premiums when those subsidies expire.
Democrats maintain they won’t vote for any spending bill unless Republicans agree to an extension of expanded tax credits that facilitate tens of millions of Americans get cheaper health insurance.
They are seizing on the prospect of consumer sticker shock, with premium payments set to double on average next year, hoping it will bring Republicans to the negotiating table.
Democrats are increasingly feeling emboldened in their position.
Republicans’ attempt to repeal ObamaCare cost them control of the House of Representatives in 2018, and Democrats are confident their strategy will produce a similar result in the midterm elections this time.
“Democrats think it’s a problem that people are going to lose their health insurance. Meanwhile, some Republicans seem to think it’s a problem that people have insurance at all. Frankly, some of my colleagues on the other side can’t open their mouths without saying, ‘Repeal ObamaCare,'” Sen. Patty Murray (D-Wash.) said Tuesday.
Republicans never voted for the expiring subsidy expansions that were first introduced and then extended twice under former President Biden. They insist that Democrats vote to fund the government before there can be any talks on health care.
Senate Majority Leader John Thune (R-S.D.) said he offered Democrats a vote on the increased subsidies if they support Republicans’ ongoing resolution to fund the government – an indication that he is at least open to the idea of an extension.
But many Republicans are pushing for a conservative overhaul of the health care system, if not a complete repeal of ObamaCare.
They also oppose funding for tax credits, which they say are bailouts of insurance companies rife with fraud.
A September analysis by the nonpartisan Congressional Budget Office estimated that a indefinite extension of the expanded tax credits would cost $350 billion over the next decade. If the loans expire, there would be almost 4 million fewer people with health insurance.
Making matters worse, President Trump has not provided a clear message on healthcare in general or increased subsidies in particular.
Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, told “Meet the Press NOW” last week that Trump has a plan to replace the Affordable Care Act.
“I firmly believe the president has a plan,” Oz said, without giving details.
Speaker Mike Johnson (R-La.) said earlier this month that he has “PTSD” from the 2017 repeal effort and acknowledged that the “roots run so deep” that a full repeal of the law would be too complex.
But when Johnson was asked during a news conference Monday whether the GOP had a plan for dealing with the expiring tax credits, he spoke of broader reforms and said the subsidies mask a broken system.
“The ObamaCare subsidy expiring at the end of the year is a serious problem,” Johnson said. “If you look at it objectively, you know it’s subsidizing bad policy. We’re throwing good money into a bad, broken system, and that’s why real reform is needed.”
Johnson said House Majority Leader Steve Scalise (R-La.) is working with the chairs of three House committees to craft a Republican health care plan.
Johnson did not elaborate on the plan or provide any other details.
“We believe in the private sector, the free market and individual providers,” he added.
Johnson highlighted previous GOP plans, including one he released in 2019 as chairman of the Republican Study Committee that closely resembled the party’s ObamaCare replacement bill, the American Health Care Act (AHCA).
Republicans in recent days have floated ideas such as expanding health savings accounts and overhauling the pharmacy benefit manager industry.
They also touted a provision in the House version of the tax-and-spending megabill to fund cost-sharing reductions for private health insurance that was removed from the final version of that legislation in the Senate.
Still, it would be complex to pass significant health care reform before the end of the year, leaving Republicans without a public plan to address the expiring expanded tax credits.
Meanwhile, people enrolled in Affordable Care Act plans are being told about hefty premium increases for 2026, putting political pressure on Republicans.
A group of 13 embattled House Republicans wrote to Johnson earlier this month that the party must “immediately shift our focus to the growing health care affordability crisis” once the shutdown ends.
“Although we did not cause this crisis, we now have both the responsibility and the opportunity to address it,” the lawmakers wrote.
Nearly six in 10 people who get health insurance through the ACA marketplace live in congressional districts represented by a Republican, according to health research group KFF.
Other prominent conservative lawmakers, notably Rep. Marjorie Taylor Greene (Ga.) and Sen. Josh Hawley (Mo.), have also sounded the alarm about the impact of rising insurance premiums.
During a private phone call with House Republicans on Tuesday, Greene said Johnson shouted for not presenting any plans for dealing with the expiring subsidies.
“Johnson said he has ideas and pages of policy ideas and relevant committees are working on them, but he refused to present a policy proposal to our GOP conference on our own conference call. Apparently I have to go to a SCIF to find out the Republican healthcare plan!!!” Greene wrote.
