Republican lawmakers are looking to craft their own health care policy overhauls by the end of next week, when Senate Democrats get a vote on expiring Obamacare subsidies. So far they don’t agree on what their competing plan should look like.
In separate closed-door meetings Tuesday, House and Senate Republicans debated what they could put forth as they face the reality that health insurance premiums will skyrocket if enhanced Affordable Care Act tax credits lapse after Dec. 31. Speaker Mike Johnson for the first time definitively promised his anxious members he would put forward some kind of health care blueprint in the coming days, while Senate Republicans discussed how to lower health care costs including through a revamp of health savings accounts.
But GOP leaders in both chambers face deep divisions within their ranks about how to proceed, including whether to extend the credits at all and force Republicans to vote for the first time to affirm Obamacare. With Tuesday’s conversations producing little clarity, GOP lawmakers said they are still far away from a plan they could unite behind by the end of next week.
“Have you ever heard of a Rorschach test? Let’s smear it all over the wall,” Sen. John Kennedy (R-La.) said about the state of the GOP’s health care discussions.
Some Republicans on Capitol Hill worry that the failure to come up with any plan in the coming days could be a political nightmare heading into the 2026 midterms, with GOP candidates being dogged by questions about increased health care costs.
Retiring Sen. Thom Tillis (R-N.C.) Tuesday warned of a potential backlash during the midterms if the subsidies expire, predicting Democrats would pummel Republicans in 2026 by highlighting a “number of sympathetic cases” where Americans have seen their health insurance costs go up.
“There’s a lot of harmonization that needs to be done,” he said about the GOP’s health care talks.
During their weekly lunch Tuesday, Senate Republicans heard from Finance Chair Mike Crapo and HELP Chair Bill Cassidy about their progress in developing a Republican proposal that could be put on the floor alongside the Democratic plan. Senate Majority Leader John Thune is giving Democrats a vote as part of a deal he struck to re-open the government.
As part of the lunch, Republicans discussed providing more flexibility for how health savings accounts are used, imposing income caps on ACA subsidies and requiring ACA enrollees to make minimum payments on premiums, according to senators in attendance.
Cassidy, a physician, has been an evangelist for boosting health savings accounts as an alternative to extending the tax credits. He’s poised to use a HELP Committee hearing on the topic Wednesday to tout this proposal.
Thune is facing competing pressures within his conference over whether the ACA subsidies should be extended or allowed to sunset. Some GOP senators said after Tuesday’s lunch they expected there would be a vote on some kind of Republican health care measure next week, but Thune wouldn’t commit to that timeline, telling reporters only that his members would continue to discuss ideas.
Crapo, in an interview, said it would be a “collective decision” from the Senate GOP Conference about whether his proposal with Cassidy would get a vote next week.
Republicans are also still waiting to see what the Democratic proposal will be. Senate Minority Leader Chuck Schumer told reporters after a closed-door lunch with his own caucus that they discussed the idea and to “stay tuned” on where they would land. Democrats are likely to offer a clean extension of the subsidies, but haven’t said how long that extension would be.
Across the Capitol, Johnson pledged Tuesday for the first time that House Republicans will put forward a health care plan soon. Many House Republicans left a closed-door conference meeting with the sense that GOP leaders could produce a framework by the end of this week.
But House GOP leaders are confronting their own internal squabbling, with one person close to leadership, granted anonymity to speak candidly, describing that goal as “ambitious.”
Leaders of the House Republican Conference have also pushed to omit any ACA subsidy extension from their upcoming health care plan, alarming GOP moderates who worry their reelection prospects hinge on the subsidies’ survival.
House Majority Leader Steve Scalise got an earful on the concerns about proceeding without an ACA extension during a lunch meeting with the centrist Republican Governance Group, according to four Republicans in the room.
One of the Republicans, granted anonymity to discuss the private conversation, said that nearly every member of that caucus complained to Scalise that “something needs to be done” on health care before the end of the year. Many of the members present advocated for an ACA subsidy extension.
Scalise didn’t make any promises but said the “will of the conference” would decide whether Republicans could back health care provisions like an extension of the ACA subsidies — though a majority of House Republicans don’t support it.
“We had a good conversation about all the work that’s been done by the three committees of jurisdiction,” Scalise said in an interview after the meeting, referring to House Energy and Commerce, Ways and Means and Education and the Workforce.
“Of course, members that aren’t on those committees, you know, haven’t been aware of some of the things that have come out, but we also wanted to get their feedback,” Scalise added.
Some Republicans are holding out hope for a bipartisan breakthrough, as GOP leaders pursue what would likely be party-line options.
House Problem Solvers Co-Chair Brian Fitzpatrick (R-Pa.) is working on a bill that reflects the leaked health care framework the White House was planning to reveal last week but held back amid conservative backlash. He told reporters Tuesday he has discussed the bill with the White House and it is “not addressing” abortion restrictions — a bid to entice Democrats.
“We’re trying to get a bill that can get 218,” Fitzpatrick said. “I think it’s the most serious attempt out there.”
Benjamin Guggenheim and Mia McCarthy contributed to this report.
