Speaker Mike Johnson said Thursday that House Republicans are close to wrapping up their health care bill. Johnson said it will be finalized Monday or Tuesday and it will get a floor vote by the end of this month.
The bill is certain to include a hodge podge of Republican health care policies — items such as an expansion of health savings accounts, insurance risk pools and a long-awaited reform of pharmacy benefit managers.
But one key question lingers: Will the bill include an extension of the enhanced Obamacare premium subsidies?
This is a critical choice for Johnson, House Majority Leader Steve Scalise and House Majority Whip Tom Emmer.
As of last night, several senior House Republican leadership sources said the decision hasn’t been made as to whether they will include an extension in the bill. Remember that the subsidies expire Dec. 31 — that’s the entire reason Congress is focused on health care at the moment in the wake of the record 43-day government shutdown.
There are pros and cons with either approach.
Including the subsidies. It’s abundantly clear to the House GOP leadership that the vast majority of the Republican conference doesn’t want to extend the Obamacare subsidies. Count Johnson and Scalise in that camp.
But the GOP lawmakers who want to extend the subsidies are the majority makers — the Republicans in districts that will be up for grabs in 2026. This includes Reps. Brian Fitzpatrick (R-Pa.), Mike Lawler (R-N.Y.) and Jen Kiggans (R-Va.).
And if you’re going to pass a health care bill in the midst of this crisis that has absolutely no chance of becoming law (this bill doesn’t), you might as well try to include an extension of the premium subsidies that are at the heart of the matter.
But you should also have no doubt that if the Obamacare subsidies are in the bill, hardline conservatives will go absolutely crazy, risking passage of the legislation and blowback for Johnson.
One option for the GOP leadership is to put together a package of several bills so lawmakers can choose what policies they want to vote on. Republican moderates could vote to extend the subsidies, conservatives could vote no and everyone could be politically satisfied.
If House GOP leaders take this path, they’d need to add Hyde Amendment language restricting the use of subsidies for abortions. Many Republican lawmakers have become convinced that’s a necessity in recent weeks as anti-abortion groups hammer the issue. But adding the Hyde Amendment language would put off Democrats.
Whichever choice the leadership makes threatens to upset a portion of the House GOP conference while tensions are already flaring. But facing political headwinds, Johnson wants a vote, so these are the tough decisions that entails.
