The Senate will move forward this week to vote on two competing proposals to prevent a surge in health care premium costs at the end of this year when a slate of COVID-19-era Obamacare subsidies expire.
The Senate will first vote on a Democratic-led proposal on Thursday that would extend the enhanced subsidies for three years without any changes or reforms — something that is all but likely to fail when it reaches the floor due to Republican opposition. Instead, GOP leaders will bring up a counterproposal that offers substantial changes to the health care system, Senate Majority Leader John Thune, R-S.D., announced on Tuesday.
“That is an alternative we will put forward and we’ll see where the Democrats come down on that,” Thune said.
The Republican plan was proposed to the party during a closed-door lunch on Tuesday, although portions of the plan have been publicly floated for weeks.
The framework, led by Sens. Mike Crapo of Idaho and Bill Cassidy of Louisiana, will not extend the ACA subsidies but would instead replace the system with new comprehensive health plans for consumers.
At the heart of the framework is a proposal to expand Health Savings Accounts, which are usually offered by companies and allow employees to set aside pre-tax dollars to use for out-of-pocket health care expenses. The proposal would require the Department of Health and Human Services to deposit payments directly to those accounts rather than using insurance companies as middlemen.
The direct payments would be paired with specific plans that insurance-holders can opt into while also implementing certain restrictions pushed by Republicans in recent months. That includes language prohibiting any health insurance funds from going toward abortions or gender treatments, among other things.
It’s not clear if the Republican-led plan will manage to get the 60 votes needed to pass the Senate as it would require at least seven Democrats to cross party lines — and Democrats have been adamant not to support anything that doesn’t include some sort of extension of the Obamacare tax credits.
Meanwhile, the House is exploring a slew of health care proposals to vote on next week — although none have received enough support to reach the floor.
House Speaker Mike Johnson, R-La., told reporters last week that he would put some sort of health care framework on the floor before lawmakers leave for the Christmas holiday. GOP leaders are expected to discuss their options during House Republicans’ weekly meeting on Wednesday morning.
One bipartisan proposal would extend ACA subsidies for one year with a few modifications, including income caps, guardrails to prevent fraud, and reforms with pharmacy benefit management. Another would extend the subsidies for two years while also expanding HSAs and cracking down on pharmacy benefit managers.
There are other plans with similar provisions being floated, but none have secured the 218 minimum votes needed to pass the House. Congress will only be in session for eight more working days, putting lawmakers in a time crunch before the Dec. 31 expiration date.