President Donald Trump appeared ready to roll out a health care proposal intended to address an imminent Obamacare subsidy cliff — a sign the White House is eager to avoid the political blowback that would likely result from a sharp rise in health care premiums.
But the White House’s decision to press pause on the rollout Monday just as quickly as they floated it underscores how difficult it’ll be, especially at this late stage, to get a bill over the finish line.
The fact that the White House was even seriously working on a plan caught Hill Republicans by surprise when news of it leaked on Sunday. By Monday morning, the White House was preparing to unveil the proposal — before eventually backtracking amid resistance from conservatives and a general sense among Republicans that the White House was mismanaging the issue.
It’s now unclear when — or even whether — the plan could see the light of day.
The proposal, detailed below, amounts to a pared-back short-term extension of the Obamacare enhanced premium tax credits, the issue Democrats latched onto as they forced the longest government shutdown in history. During that shutdown, Republican leaders in both chambers said repeatedly that they didn’t support extending the subsidies despite modest support within the GOP rank-and-file.
Our friends at the WSJ report that Speaker Mike Johnson called the White House to warn them that most Republicans oppose an extension.
The plan, though, mirrors what some GOP senators, most notably Sen. Katie Britt (R-Ala.), were privately pitching to Trump last week as a way to buy time for a larger health care fix and, simultaneously, prevent politically damaging premium hikes in the near-term, as we scooped.
Democratic Sens. Jeanne Shaheen (N.H.), Jacky Rosen (Nev.) and Maggie Hassan (N.H.) — all of whom voted to end the shutdown — issued statements welcoming Trump’s push.
Shaheen, for example, called it “a serious proposal to begin negotiations” and expressed optimism that a bipartisan deal can be reached.
Republicans were a lot less excited about the proposal, concerned about the overall policy and, perhaps more critically, whether it protects the Hyde Amendment, which prohibits taxpayer money from being spent on abortion.
But there’s precious little time — and lots of uncertainty about whether there’d be enough support within both parties to get something done.
New phase. As part of the deal that ended the shutdown, Senate Majority Leader John Thune promised to hold a vote on the Obamacare subsidies by Dec. 12. That’ll be just 11 days from next Monday, when both chambers return from the Thanksgiving recess.
Lawmakers from both parties have long said Trump’s involvement is critical given his tight grip on Senate and House Republicans, so it’s no surprise that Democrats who want to extend the subsidies are feeling optimistic.
But Trump’s apparent pullback on Monday shows how difficult even a pared-back Obamacare extension is for Republicans to swallow.
There’s always been a distinct possibility that Thune’s promise of a vote simply becomes a messaging exercise for Democrats whereby they all vote for a clean extension of the subsidies, it falls well short of 60 votes, and everyone moves on with their lives.
The alternative, of course, is a compromise product that extends the Obamacare subsidies in some form. A key unknown variable here is what exactly the coalition looks like to win 60 votes. Is it nearly every Democrat and a handful of Republicans? Or vice-versa? Or is it more like 30-40 senators from each party?
If the starting point is a Trump-backed bill, the vast majority of the Senate GOP Conference will likely support it. The question is whether there are enough Democrats to supply 60-plus votes. Last week, top Senate Democrats were publicly casting doubt on the prospects of an Obamacare extension deal, while many progressives probably won’t vote for anything that isn’t a clean extension.
It’ll be a similar calculation in the House, where Johnson would likely need a good chunk of Democratic votes to make up for the Republicans who will never vote for an Obamacare extension even with Trump’s prodding.
That dynamic would be tricky territory for Johnson. Republican speakers of the House are sensitive to criticism that they are relying on Democrats to pass legislation. Johnson also likes to say that his job is to build consensus among Republicans.
The proposal. The White House was floating policies that would extend the expiring subsidies for two years but add guardrails, including capping eligibility at incomes of 700% of the federal poverty level.
Enrollees would also owe a minimum premium payment, and there would be an option to receive part of the credit in an HSA if enrollees buy lower-premium options on the ACA exchange.
The income cap is in line with what a bipartisan Senate group was discussing, though it falls short of letting the subsidies expire, which is what conservatives would prefer. But pitching an Obamacare credits extension without much input from congressional Republicans rankled many GOP lawmakers.
What wasn’t in the proposal was also a concern for some Republicans. Anti-abortion groups and their GOP allies have been demanding Hyde amendment language be added to any fix on Obamacare subsidies. Democrats won’t go for that.
