Republicans who had months to fight over the fate of expiring Obamacare subsidies are now faced with a flurry of proposals from across the conference attempting to fill the legislative vacuum.
And all of them appear to be doomed.
Many in Congress see little chance of bipartisan agreement when senators vote next week on the subsidies, whose pending expiration fueled a six-week government shutdown that ended last month only after Majority Leader John Thune promised Democrats a vote on an extension.
“Some of our folks who are working on this issue are trying to come up with something that unites Senate Republicans,” Thune told POLITICO this week, adding that there are “consultations going on all the time with the White House.”
Senate Democrats on Thursday unveiled a plan for extending the subsidies for three years that’s unlikely to win much, if any, Republican support. The GOP has opposed the Affordable Care Act since Democrats created it in 2010 and none voted for increasing the premium subsidies when Democrats did that in 2021.
Still, Republicans are split between those who prefer to do nothing, a wing insisting on a far-reaching conservative overhaul of Obamacare, and those who are worried about the political consequences of rising premiums.
While GOP senators are considering whether to make an official counterproposal to the Democratic bill, the divergent views within their own conference are likely to make it hard to coalesce around a singular plan.
GOP leaders are looking to present a suite of bills from three House committees — Ways and Means, Energy and Commerce, and Education and the Workforce — that would revamp Obamacare premiums. Speaker Mike Johnson says he expected to settle on something early next week.
Subsidy levels will return to the levels Democrats set in 2010 if the enhanced ones expire.
Many low-income Obamacare customers pay nothing now, but will have to pay something if the enhanced subsidies go away, and people earning more than 400 percent of the poverty level — an individual making at least $62,600 a year — will pay a lot more. On top of that, no one purchasing an Obamacare plan today pays more than 8.5 percent of their income, but an income limit on subsidies will take effect if Congress doesn’t act.
Here’s what the key players on both sides of the aisle have proposed for making health care more affordable before the enhanced subsidies end this month:
Donald Trump: Before Republican blowback, the president was poised to release a framework last month to extend the subsidies temporarily.
The White House plan was expected to limit the subsidies to individuals with incomes below 700 percent of the federal poverty level — those making less than $109,550. It also would have instituted a minimum premium requirement in response to conservatives' concerns that the creation of zero-premium plans in 2021 provided an opportunity for fraud in which unscrupulous brokers enroll people in plans without telling them and extract the subsidies.
Trump backed down, POLITICO reported, after Republican lawmakers insisted that any subsidy extension restrict Obamacare plans from covering abortions, and that any deal include more conservative changes to the program.
Thune said this week the abortion issue was “a difficult and challenging one on both sides.”
Chuck Schumer: The Senate minority leader voted against ending the shutdown and believes Democrats’ stand has put Republicans on the defensive as an election year looms.
He announced this week a plan to extend the subsidies for three years without limits or income caps that Republicans want and bipartisan groups of lawmakers have proposed.
During the record-long shutdown, the New York Democrat discussed adding a one-year extension of the subsidies to a stopgap bill to reopen the government. Democrats are rallying behind a simple extension of current rules.
“This is the bill, a clean three-year extension of ACA tax credits, that Democrats will bring to the floor of the Senate for a vote next Thursday, and every single Democrat will support it,” Schumer said Thursday. “Republicans have one week to decide where they stand.”
Schumer’s previous plan called for a bipartisan committee to negotiate a longer-term solution for the subsidies before next year’s enrollment period, which begins on Nov. 1.
At the outset of the shutdown, Democrats had said they wanted a permanent extension of the subsidies.
Bill Cassidy: The Louisiana Republican has clout on his side of the aisle that could make his plan the one Republicans offer next week. As chair of the Senate committee that oversees health policy, he said last month he’d like to encourage Americans to sign up for high-deductible insurance plans by redirecting the enhanced subsidies to the tax-advantaged health savings accounts that come with them.
Trump had earlier said he wants to take the subsidy money and send it directly to Americans.
Cassidy's proposal would try to implement that by requiring people to switch to bronze-level Obamacare plans that offer lower premiums and higher deductibles.
He has said funding subscribers’ HSAs would allow people to afford higher out-of-pocket health care costs. Enrollees could better cope with rising premiums by opting for the marketplace’s cheapest plan tier. However, HSA rules bar using the money in them to pay premiums.
Rick Scott: More people in Florida get their insurance on the Obamacare marketplace than any other state, and Democrats have tried to make sure they know what’s happening with their subsidies.
The GOP senator has responded with a bill to turn the subsidies into “Trump Health Freedom Accounts,” a new type of health saving account that could be used to pay premiums.
Scott’s proposal would also allow people to shop for insurance plans across state lines using a state waiver program within the Affordable Care Act. It could be under consideration if Republicans offer a counterproposal to Democrats’ subsidy extension.
Josh Hawley: The Missouri senator is a populist on health care issues. Earlier this year, he warned fellow Reublicans big cuts to Medicaid, the federal-state insurance program for low-income people, were “morally wrong and politically suicidal” but ultimately voted for cuts in Trump’s One Big Beautiful Bill Act anyway.
Hawley later introduced legislation to prevent future cuts and to shore up rural hospitals.
He says he’s also concerned about rising insurance premiums and that he’s broached an idea with Trump of letting people deduct medical expenses from their incomes at tax time. Trump liked it, he said.
Currently, only taxpayers who itemize deductions can write off unreimbursed medical expenses that exceed 7.5 percent of their adjusted gross income. Hawley’s plan would allow deductions of up to $25,000 for anyone.
The idea is unlikely to move now, but could come into play if Republicans pursue another major budget and tax bill in 2026, as could Scott’s proposal.
A bipartisan plan: Moderates and representatives in competitive districts are particularly worried about the consequences if Congress fails to do anything about the subsidies and rising premiums.
Nearly three dozen, led by Reps. Jen Kiggans (R-Va.) and Josh Gottheimer (D-N.J.), wrote to House and Senate leaders of both parties on Thursday urging a deal.
“I have 40,000 people in my district who rely on this health care and doing nothing to prevent a spike in their premiums is wrong,” Kiggans, who won a second term representing a district on Virginia’s southern coast last year, said at a briefing that day.
Their proposal would retain the enhanced subsidies for people earning up to 600 percent of the poverty level for a year, with reduced amounts for people earning up to 10 times the poverty level.
They’d also implement new anti-fraud measures.
Kiggans won reelection last year by less than 4 percentage points and is in a seat that’s expected to be hotly contested in 2026.
Colleagues who’ve joined the effort are in a similar situation, including Democrats Adam Gray of California, Greg Landsman of Ohio, Henry Cuellar of Texas, and Marie Gluesenkamp Perez of Washington and Republicans Juan Ciscomani of Arizona, David Valadao of California, Tom Kean of New Jersey, and Ryan Mackenzie of Pennsylvania.
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