Opening Bids On Healthcare Bills
This article should really be seen as a continuation to yesterday's article, since all it does is add some specifics to the generalized observations I made yesterday. Because both sides in Congress have made some tangible moves in the debate over extending the Obamacare subsidies (which are set to expire on the first of the year). Senate Democrats have presented their plan, which will get a guaranteed floor vote next week, while a centrist group in the House (with enough Republicans to pass a bill if all Democrats supported it) has come up with their own plan. Meanwhile, Republicans in both the House and the Senate are still dithering about what party-line plan they might put forward. So let's run these down, one by one.
Schumer's plan
Senate Minority Leader Chuck Schumer had a choice. He could have introduced a bill that was designed to get as many Republican votes as it could, or he could have put forward a Democratic bill that makes no concessions to the Republicans at all. He chose the latter.
Schumer's problem is that he's got a very steep hill to climb. To pass any bill, he's going to need at least 13 Senate Republicans to vote for it. There has been a bipartisan group working on such a bill, but the GOP numbers never added up to 13. As one Democrat put it:
"They couldn't put pen to paper," Sen. Peter Welch (D-Vermont) told reporters, referring to Republicans. "They couldn't propose something that was concrete, where they could say, 'We've got four votes or five votes or six votes.'"
Faced with this reality, Schumer could have offered up a bill that might have gotten a few GOP votes, but still would have failed. Or he could have done what he did -- present a bill that is definitely going to fail, as a political marker: "This is what Democrats are united behind."
The bill Schumer unveiled would extend the Obamacare subsidies for three years (instead of the one or two that Republicans might have accepted), and it is as clean a bill as can be (there are no GOP ideas included whatsoever, the bill would simply extend the date when the subsidies expire to the very end of Donald Trump's term).
This could turn out to be one of two things: a bargaining position, or the centerpiece of the Democrats' midterm campaign strategy. We'll see if Senate Republicans return to the table and continue negotiating or whether they just throw up their hands and walk away. It's kind of a gamble, but at this point Schumer sees it as his best option. When introducing the bill, Schumer tossed down the gauntlet: "Republicans have one week to decide where they stand: Vote for this bill and bring health care costs down, or block this bill and send premiums skyrocketing."
House bipartisan plan
There are more House Republicans than GOP senators who are genuinely concerned about the looming problem, either by the fact that the premium hikes are going to hit their own constituents very hard (the charitable way of looking at it), or by the fact that they may lose their re-election bid if this problem isn't fixed (the selfish way of looking at it). Either way, there are enough of them who truly are worried that they've been a real force behind the push to get some sort of compromise across the finish line. So here's what they've come up with:
A group of 35 House Republicans and Democrats on Thursday released a plan to scale back and extend for two years the Affordable Care Act subsidies set to expire at the end of the year, a long-shot effort to address soaring health care premiums.
. . .
The new House proposal, led by Representatives Josh Gottheimer, Democrat of New Jersey and Jen Kiggans, Republican of Virginia, would extend and reduce the tax credits in a two-step process, requiring two separate votes by Congress. The first vote would extend the tax credits for a year with some modifications, including the addition of a new income limit. The second would implement what the group described as "more significant reforms," including potentially eliminating $0 premiums, with exceptions for need-based support.
"We're calling for a vote by Dec. 18 in both chambers of Congress to get something done before premiums rise in January," Mr. Gottheimer said at a news conference at the Capitol on Thursday. "As part of our plan, we'll also work together on a menu of longer term reforms to help families continue to save on their premiums."
Ms. Kiggans said she had "40,000 people in my district who rely on this health care."
"Doing nothing to prevent a spike in their premiums is wrong," she said.
Importantly, the article notes that there are 15 Republicans in that group -- which are more than enough to pass a bill, if all (or almost all) Democrats get behind it. This is actually a walkback from what the Republicans were initially asking for, it's also worth pointing out. The Republicans who are serious about the effort have wanted two restrictions added to the subsidies all along, but without also demanding poison-poll ideas (such as language about abortion) that would be unacceptable to Democrats. They wanted an income cap on who could receive benefits, and they wanted to make sure everyone on such a plan paid at least a very minimal monthly amount (to counter fraudulent accounts being created). But their new bill splits the process in two (with another required vote from Congress), which should be even more acceptable to the Democrats.
Speaker Mike Johnson probably won't even let this bill have a floor vote, but the Republicans involved in the effort are so adamant that something be done that they're putting together a discharge petition -- which could force a vote (if it gets 218 signatures, which seems likely). So the House could pass this bill (with some GOP support and overwhelming Democratic support), which would amp up the pressure on the Senate to act.
Other possibly-mythical Republican plans
There are two other efforts to produce something very quickly, but your guess is as good as mine as to whether either of them will become reality any time soon. The first comes from the House, which seems to be taking a very "throw everything at it but the kitchen sink" approach (where extending the Obamacare subsidies is the "kitchen sink" that they couldn't quite bring themselves to throw). This mishmash would be designed so that Republicans could then go campaign on the notion that: "Well, we voted for a wonderful plan to reduce healthcare costs, but those dastardly Democrats wouldn't vote for it!" Here's how Politico reported on the effort:
Speaker Mike Johnson is racing to finalize a Republican health care plan in time to present it to his conference at their weekly meeting Tuesday, but his team still needs to decide on major contours of the plan, according to three people granted anonymity to describe internal conversations.
GOP leaders are meeting Thursday to nail down what will go in the package, according to the three people. One major decision still to be made is whether to offer multiple individual bills for floor consideration or to assemble them into one piece of legislation. But top Republicans want to have a GOP alternative to vote on as Democrats hammer them over expiring Obamacare subsidies that will spike premiums for millions of Americans in the new year.
If Johnson and fellow GOP leaders don't make decisions about the way forward Thursday, one senior House Republican said, "it's going to be bad."
The package is likely to be an assemblage of various GOP bills that have been working through House committees that are largely aimed at providing more options for health care coverage outside of the Affordable Care Act framework. One likely to be included would provide for "association health plans" allowing smaller businesses to join together to offer plans rather than going through ACA exchanges. Leaders are also likely to include options for expanding the use of health savings accounts, something President Donald Trump has endorsed but Democrats have generally opposed.
It's also likely to include bipartisan legislation overhauling the role of pharmacy benefit managers and potentially other bills that could lower prescription drug prices -- something Trump pollster Tony Fabrizio advised a group of House Republicans to focus on as Democrats seize on the expiring tax credits.
The safe bet here is that Johnson can't bring enough of his own party together on any plan, no matter what it contains, and his effort falls apart completely. That's just judging on past performance, mind you.
Senate Republicans are also hoping for a pie-in-the-sky healthcare bill to somehow magically appear:
Senate Republicans have discussed holding a vote next week on a health care bill of their own but have not reached a decision. Sen. Roger Marshall (R-Kansas) said such a bill could include funding for health savings accounts, more money for rural hospitals and legislation he introduced with Sen. John Hickenlooper (D-Colorado) to force health care providers to make prices public.
"If you give patients price tags, we put some money in their health care savings accounts, then we're going to drive down the cost of health care for everybody," Marshall said.
You'll notice that this bill (just like the House bill) would also not extend the Obamacare subsidies, which is the immediate problem staring tens of millions of Americans in the fact, come New Year's Day. The proposed GOP "solutions" don't actually solve the problem, plain and simple.
Conclusions
The problem for Republicans (in either house) is the same one that has bedevilled them all along: when the public actually gets to see any GOP healthcare plan, they don't like it. They'd much prefer what the Democrats are offering. This is why throughout the entire decade of their "Repeal and replace Obamacare!" frenzy, Republicans never managed -- not once -- to put together any sort of plan that was even remotely as good as Obamacare. Mostly they just punted and tried to sell the idea: "Trust us! We'll repeal Obamacare and then at some future date we'll unveil our plan to replace it and it will be wonderful!" They're going to run into this same basic problem once again, in both houses of Congress. Because any GOP-only bill will (just like Schumer's) be designed to fail. Because no Democrat is going to vote for it.
So the best chance (as things stand right now) for the problem actually to get solved is for the bipartisan group in the House to force a floor vote with a discharge petition, pass their bill, and then send it over to the Senate. Maybe the Senate will tinker with it, maybe they won't, but if a vote is held on a bill (or close to one) that has already passed the House, it could actually wind up on Donald Trump's desk.
That's a very narrow legislative path to navigate, though. But it is at least one ray of hope.
-- Chris Weigant
Follow Chris on Twitter: @ChrisWeigant

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