Doomed Health Votes Double as Political Weapons for Democrats

The Senate will vote on dueling health care bills Thursday to stave off a spike in insurance premiums next year — a likely futile exercise that almost guarantees pain for Obamacare enrollees in January, and a political cudgel for Democrats in November.

Senate Democrats are bringing to the floor legislation to extend enhancements to Affordable Care Act premium subsidies for another three years — a nonstarter with most Republicans. Conversely, Republicans will counter with a proposal that allows those credits to expire while creating federally funded health savings accounts for certain Affordable Care Act plans, with an income cap at 700% of the federal poverty level.

The enhancements, set to expire after 2025, made the tax credits larger and more available to people of higher income levels. Without an extension, premium payments are expected to soar for enrollees. And Senate Democratic leaders’ decision to put forward a lengthier extension — even as bills emerge in both chambers coalescing around a two-year continuance — looks more like early election-year politics than policy, according to some Republicans.

“My assessment, that they want a political weapon,” Sen. Bill Cassidy (R-La.) said Tuesday. “I’m hoping that is not true.”

Cassidy, a doctor who chairs the Senate Health, Education, Labor and Pensions Committee, worked with Sen. Mike Crapo (R-Idaho), chair of the Senate Finance Committee, on the Republican alternative.

“They’re after a political issue to attempt to batter Republicans with during this next election year,” Senate Majority Leader John Thune (R-S.D.) said of Democrats’ proposal.

Sen. Markwayne Mullin (R-Okla.) also asserted it was all about politics. “There’s no serious solution,” he said.

Moderate Sen. Lisa Murkowski (R-Alaska) said the three-year extension is the Democrats’ effort to figure out what unifies their conference. “The problem is, what unifies their conference is not going to get 60 votes,” she said.

Either of the two bills Thursday would need 60 votes to advance.

‘Moment of Truth’

Democrats are using the vote to pin the premium spike on the majority. Senate Minority Leader Chuck Schumer (D-N.Y.) on Wednesday called it a “moment of truth” for Republicans, deeming it “one of the most important votes” of this Congress.

Sen. Amy Klobuchar (D-Minn.) said if Republicans don’t join them on the extension, then “we are going to march into the midterms against your resistance and win and get this done.”

The most vulnerable Democratic incumbent in the chamber, Sen. Jon Ossoff (D-Ga.), pitched the three-year extension as “life or death” for constituents in his state — previewing the issue as key to one of the more critical midterm races.

The politics of the increased premiums is drawing concerns from Republicans who are worried about how it will impact the caucus in elections. Some Senate Republicans pressed leaders to put up a bill for a side-by-side vote to show they are making their own effort on health care.

“They don’t want to hear another excuse for why we’re not doing anything,” Sen. Josh Hawley (R-Mo.) said. “They want to hear us saying we are trying everything we can to bring down your costs.”

While some Republicans agree that Democrats’ three-year proposal was intended to be a political messaging effort, there are divisions over whether the GOP’s vote will help in the midterms.

Sen. Thom Tillis (N.C.), a retiring Republican with the least to lose, said the side-by-side vote is a “wash” since constituents will remember their premiums increasing, not a show vote.

“At the end of the day, health care is going to be a key theme next year, and we need a solution to health care,” Tillis said.

Votes May Spur Talks

Despite the polarizing strategies, some senators suggested bipartisan conversations could pick up once both partisan proposals fail. Cassidy expressed willingness Tuesday to negotiate on a possible short-term extension of the credits, without committing to a specific timeline, as long as it leads to alternatives like HSAs.

Senate Republicans released various health care proposals this week, including one from GOP Sens. Bernie Moreno (Ohio) and Appropriations Committee Chair Susan Collins (Maine) to extend the expiring subsidies for two years with income cap restrictions and minimum premium payments that could spur some Democrat interest.

In the House — where a three-year extension would be dead on arrival — moderates from both sides are pushing for two bipartisan bills with one-and two-year extensions. Bill sponsor Rep. Brian Fitzpatrick (R-Pa.) filed a discharge position Wednesday to circumvent House leaders and bring his bill straight to the floor for a vote, while Reps. Jen Kiggans (R-Va.) and Josh Gottheimer (D-N.J.) released the text of their bill the same day.

Thune said there are conversations happening with rank-and-file members across the aisle that could lead to a “path forward” for the subsidies. But abortion restrictions are likely to be a sticking point even in bipartisan talks.

There’s also little time on the congressional calendar. Both the House and Senate are scheduled to depart Washington for the rest of the year after next week.

“When we get through this exercise this week,” Thune said Wednesday, “the question is: Are there enough Democrats who actually want to fix the problem, to work with the Republicans?”