GOP wrestles with Obamacare fixes

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MYRNA BROWN, HOST: It’s Thursday the 11th of December.

You’re listening to WORLD Radio and we’re so glad you’ve joined us today. Good morning, I’m Myrna Brown.

MARY REICHARD, HOST: And I’m Mary Reichard.

First up on The World and Everything in It: competing plans for healthcare in this country.

The Senate votes today on two competing plans about extra Obamacare subsidies that end this year. Democrats want to extend the subsidies for three more years, keeping COVID-era benefits in place.

BROWN: Republicans want to let the subsidies end, and use the same money for a new plan that still sends money to Obamacare recipients.

WORLD reporter Carolina Lumetta has the story.

CAROLINA LUMETTA: With only a few weeks left in the year, Senate Republicans have proposed a variety of options for dealing with rising premiums…five of them to be exact.

SUSAN COLLINS: I think there’s a limit to what we can do in this first year.

Senator Susan Collins of Maine and Ohio Senator Bernie Moreno filed a bill that would extend the expiring subsidies for two years. Their bill also includes reforms to add a minimum $25 monthly payment and a promise to phase out the subsidies for the highest earners. Then, on Tuesday, the junior Ohio Senator Jon Husted filed a similar bill that has slightly different reforms… and would add Hyde Amendment protections to keep insurance plans from funding abortions.

HUSTED: There are a dozen small steps or even moderately successful steps that we can take to reduce the overall cost of health care in this country.

Kansas Senator Roger Marshall also has a plan to extend Affordable Care Act subsidies by a year, along with yet more reforms. Florida Senator Rick Scott suggested setting up “Trump Health Freedom Accounts” instead of extending the subsidies.

But the plan that has the backing of Majority Leader John Thune is the one that’s a nonstarter for Democrats.

THUNE: I can't say 100% but I think for the most part I would argue we are united behind the Crapo-Cassidy proposal which as I said uh in terms of its emphasis is about patients not insurance companies and about lowering premiums not increasing them and about getting a better return for the federal taxpayer.

The proposal, filed by Bill Cassidy of Louisiana and Mike Crapo of Idaho, would redirect the subsidy funds to individual health savings accounts. Here’s Senator Cassidy.

CASSIDY: Under our plan, they can choose the less expensive bronze plan. … So we have lower cost premiums and money for out-of-pocket expenses off the bat. That is more affordable. That is a better plan.

The monthly subsidy could not be put toward the premiums but can be used for other healthcare expenses that insurance doesn’t cover. It also includes language to apply the Hyde Amendment to ACA plans.

But many senators, including Republicans, want to buy time for more substantive changes later. North Carolina Senator Thom Tillis, says now is not the time for overhauling American healthcare policy.

TILLIS: You could argue whether or not the subsidy should have ever been passed, but they are what they are, and people are relying on them. It makes more sense to extend it and bend the curb in the out years.

Although most Senate Democrats have said they’re open to discussing reforms to enhanced subsidies, they insist on extending the program. Democratic Vermont Senator Peter Welch told me it would be fastest for Democrats to give Republicans a few reforms while ensuring subsidies are extended. But it depends on the reforms Republicans insist on.

WELCH: So we can extend them as long as what we're talking about is maybe an income cap or a modest co-pay. But if you're introducing a whole new concept, transforming it to HSAs, that's a fierce policy debate. And it's a proposal that has no prospect of passage in the next two weeks.

But why the political urgency? According to recent Gallup polling, the majority of Americans generally approve of Obamacare. And other polling found the vast majority of Obamacare enrollees, including Republicans, want Congress to keep their subsidies intact. That leaves Republican lawmakers caught between subsidizing a program they hate or taking the blame in a midterm election year for higher premium costs.

SHELTON: There's a lot of concern that all these promises for cutting spending, for rolling back government overreach and excess that began with DOGE and went into the shutdown have kind of died.

John Shelton is the policy director at Advancing American Freedom, a think tank founded by former Vice President Mike Pence.

SHELTON: We're now just getting our Republican versions of Obamacare.

He says that even the Crapo-Cassidy bill is built on the assumption that lawmakers should continue subsidizing a program that doesn’t work.

SHELTON: If premium costs continue to go up, then more government spending will always be justified. And so as a conservative, I just think that's not right. That's not what government is supposed to do. It’s supposed to get out of the way. We don’t have a responsibility to endlessly subsidize a system that’s broken.

Since its initial passage in 2010, Obamacare coverage fees have climbed nearly 130%, according to data from the Paragon Health Institute. The enhanced subsidies passed during the Biden administration amount to a small portion of the overall subsidies available to enrollees. Paragon President Brian Blase spoke to me after he testified at a Senate Finance Committee hearing last month.

BLASÉ: 94% of enrollees would receive subsidies next year and they would cover the vast majority of the cost of the premium. So I think it's essential that Congress stops throwing… good money after bad and allows the enhanced subsidies to expire, and then there’s a host of reforms that Congress should consider.

Most other reforms would take too long to apply to next year’s Obamacare plans, and possibly even Cassidy’s bill. After Thune decided to bring that one up for a vote, Moreno took his version out of consideration. But he reminded reporters in the Senate basement that even 53 Republicans aren’t enough to pass a plan..

MORENO: We're going to focus, hyper-focus on the Cassidy-Crapo plan. Make sure we get that across the finish line. And then it's going to be, as you know, you got to report accurately. We do need 60 votes. So we've got to get some Democrats to support it.

Reporting for WORLD, I’m Carolina Lumetta in Washington.

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