House Republicans are facing significant challenges as they attempt to finalize a health care plan ahead of a crucial vote scheduled for next week. This comes as millions of Americans are poised to see a rise in insurance premiums if Congress does not extend subsidies for the Affordable Care Act (ACA) by the fast-approaching deadline of December 31, 2023.
Under pressure from conservatives, House Speaker Mike Johnson, a Republican from Louisiana, is leading discussions on a proposal that would not extend these subsidies. Instead, the plan suggests providing funds to help Americans manage their health care expenses. This stance is met with resistance, particularly from Republicans in competitive districts, who argue that any health care initiative must be bipartisan and include an extension of the ACA subsidies to mitigate rising costs.
After a recent closed-door meeting, Republican Representative Ralph Norman of South Carolina expressed the prevailing sentiment among his colleagues: “The consensus is we need to come up with something.” This urgency is underscored by the looming deadline, as Republicans aim to shield their party from Democratic critiques regarding escalating health insurance costs and to maintain their precarious majorities in the House and Senate.
During the meeting, Representative Jim Jordan of Ohio cautioned that failing to include some extension of ACA funding may lead moderate Republicans to collaborate with Democrats to advance legislation through a discharge petition, which would allow the proposal to bypass leadership. Johnson has indicated his intention to hold a vote on a GOP plan next week, just before lawmakers leave for a two-week recess.
In discussions, House Republicans have explored various options, including expanding health savings accounts and funding cost-sharing reductions. Johnson noted, “We have some low-hanging fruit… some things that every Republican agrees to; Democrats won’t. Remember, they don’t actually want to fix this problem.”
Nevertheless, some Republicans acknowledge that a comprehensive reform of the ACA—a topic that has challenged the GOP for nearly 15 years—will require more time and effort. Representative Dusty Johnson of South Dakota commented, “Health care is unbelievably complicated. You’re not going to reform and bring down costs overnight.”
Amidst the division, a group of 15 House Republicans representing swing districts recently endorsed a bipartisan framework led by Representatives Jen Kiggans of Virginia and Josh Gottheimer of New Jersey. This proposal seeks to extend the ACA subsidies for two years, with certain modifications. However, their influence is limited within the larger Republican conference, where many members are resistant to any measures that would support what they term “Obamacare.”
Johnson appears to be aligning with the majority of his party, which shows reluctance toward extending ACA tax credits. One GOP lawmaker remarked that the Speaker is “drawing a line in the sand” against such extensions. It remains uncertain whether proponents of extending ACA funding can successfully rally support to employ a discharge petition, a tactic that would require a majority of the House—218 members—to force a vote.
Additionally, centrist Representative Brian Fitzpatrick of Pennsylvania has introduced his own plan for extending ACA subsidies, which he claims has input from both the Senate and the White House. His proposal includes extending tax credits for two years and expanding access to health savings accounts. Fitzpatrick has signaled his willingness to file a discharge petition if leadership fails to act on his initiative.
Despite these efforts, achieving the necessary signatures to force a vote remains a daunting challenge. A Democratic leadership aide has voiced concerns that some provisions within Fitzpatrick’s bill may be impractical to implement in the upcoming year.
Representative Jeff Van Drew of New Jersey argues that extending ACA subsidies is crucial for protecting vulnerable Republicans and maintaining the party’s slim majority. He warned that allowing these subsidies to lapse could cost the GOP valuable seats in the midterms. Van Drew stated, “If you’re a conservative and you’re a Republican, do you want a Democrat majority next year? … Let’s not be self-destructive.”
While the House may move forward with a vote, any legislation passed would still need to navigate the Senate, where its fate is uncertain. Representative Ted Lieu from California indicated that Republicans should have prioritized a discharge petition months ago. He emphasized the urgency of extending ACA tax credits to prevent a surge in health care premiums. “Now there’s nothing keeping Republicans from doing it for two years, and then we can work on legislation for those reforms,” Lieu added.
As the deadline approaches, the struggle among House Republicans highlights deep divisions within the party and the complex landscape of health care reform. The outcome of this vote could have significant implications for the party’s future and for millions of Americans reliant on affordable health care.
