House Republicans are under pressure to finalize a health care plan before the holiday recess, but internal disagreements complicate their efforts. A key issue is the expiration of subsidies for the Affordable Care Act (ACA) on December 31, 2023, which could lead to significant increases in insurance premiums for millions of Americans if Congress does not act.
House Speaker Mike Johnson of Louisiana, along with his leadership team, is pushing a proposal that does not extend the ACA subsidies. Instead, they seek to offer limited funds to help Americans manage health care costs. This approach has drawn criticism from some Republicans who are facing challenging re-election campaigns in the upcoming midterms. They argue that any health care package should include bipartisan support and an extension of the subsidies.
The looming deadline has intensified discussions among Republicans. “The consensus is we need to come up with something,” stated Rep. Ralph Norman of South Carolina, a member of the conservative Freedom Caucus, following a closed-door meeting on the issue. In that meeting, Rep. Jim Jordan of Ohio emphasized the necessity of including some extension of ACA funding alongside conservative reforms. Failure to incorporate this funding could lead moderate Republicans to collaborate with Democrats to force a vote on a health care bill through a discharge petition.
Johnson has indicated plans for a floor vote on a GOP proposal next week, just before lawmakers begin a two-week recess. Among the strategies discussed in recent meetings were expanding health savings accounts and funding for cost-sharing reductions. Johnson expressed optimism, saying, “We have some low-hanging fruit. We have some things that every Republican agrees to; Democrats won’t. Remember, they don’t actually want to fix this problem.”
Despite this optimism, several Republicans acknowledged that overhauling the ACA is a complex issue that cannot be resolved quickly. “Health care is unbelievably complicated,” remarked Rep. Dusty Johnson of South Dakota. “You’re not going to reform and bring down costs overnight.”
A group of fifteen House Republicans, primarily from competitive districts, has recently signed onto a bipartisan framework proposed by Reps. Jen Kiggans of Virginia and Josh Gottheimer of New Jersey. This plan aims to extend ACA subsidies for two years with certain modifications. However, this faction is outnumbered within the Republican conference, where many members oppose extending any ACA funding.
Johnson appears to align with the majority of his colleagues who reject extending the subsidies. According to an anonymous GOP lawmaker, the Speaker is “drawing a line in the sand” against ACA tax credits. Whether those favoring an extension can successfully utilize a discharge petition to circumvent Johnson remains uncertain. Such petitions require a majority of the House, meaning at least 218 members must support the effort.
In addition to the Kiggans-Gottheimer framework, Rep. Brian Fitzpatrick of Pennsylvania has proposed his own plan to extend ACA subsidies, which he claims has received input from the Senate and White House. This proposal includes tax credit extensions and access expansion to health savings accounts. Fitzpatrick warned that if leadership does not act, he may resort to filing a discharge petition to force a vote.
Despite these efforts, the reality remains that any bill passed by the House would still require Senate approval, which is not guaranteed. Even if a vote occurs, it is likely to happen after the ACA funding has expired, as noted by Representative Ted Lieu of California, a member of Democratic leadership.
Lieu criticized Republicans for not taking the discharge petition seriously earlier, stating, “These ACA tax credits expire at the end of this month, and so the procedural problems will make it so that everyone’s health care premiums skyrocket.” He urged Republicans to extend the ACA tax credits and work collaboratively on future reforms to avoid impacting millions of Americans negatively.
As the deadline approaches, the stakes are high for House Republicans. Allowing the ACA subsidies to lapse could prove detrimental to their political prospects in the midterm elections, as noted by Rep. Jeff Van Drew of New Jersey. He stressed the importance of extending the subsidies, stating, “If you’re a conservative and you’re a Republican, do you want a Democrat majority next year? I don’t think so.”
With the clock ticking, House Republicans must navigate their internal divisions carefully to avoid potential consequences that could affect their electoral standing and the health care coverage of millions of Americans.
