Health insurance premiums on the Affordable Care Act’s marketplaces are set to soar after Congress failed Thursday to pass a last-minute plan to avert the rate hikes.
As many as four million people could be forced to go uninsured, because they can no longer afford their health plan. I spoke with some of them earlier this fall. These are working parents, entrepreneurs, and retirees — all now facing impossible choices because of the loss of their government aid.
They are fed up with their livelihoods being exploited for politics, and it’s this population — those with health insurance subsidized by the federal government — who, in particular, think Republicans have dropped the ball.
A recent survey found that 76 percent of people who get their insurance through the ACA and want the subsidies extended would blame President Donald Trump or Republicans in Congress if they are not. The broader public, the vast majority of whom would also like to see the aid extended, agrees; 48 percent of voters blame the GOP, while 32 percent pin it on the Democrats, per a new Morning Consult poll.
On Thursday, the Senate failed to pass two partisan measures that were designed to avert premium spikes. One proposal from the Democrats would have extended the financial subsidies for three more years; it failed 51-48, with all Democrats and four Republican senators supporting it. The rest of the Republicans objected, and 60 votes were needed for the bill to advance. The other plan, put forward by Republicans, would’ve put money into a health savings account and pushed people to purchase catastrophic coverage with a higher deductible. It also fell short, at 51-48, with unified Democratic opposition.
The only reason these votes happened at all is that the two parties agreed to end the government shutdown earlier this fall on the condition that the Senate would hold a vote by mid-December on a then-unspecified plan to restore the subsidies.
Democrats had been pressing Republicans to address the assistance ahead of the shutdown and during the shutdown. Republicans, however, refused to negotiate at the time and failed to come up with a unified plan to fix the issue — until only a few days before the planned vote.
Now, patients will have to pay their new, much higher premiums when coverage begins on January 1. And unless Democrats are willing to shut down the government again on January 30, when the current funding bill runs out, there likely won’t be another chance to fix the problem any time soon.
Americans are right to blame the Republicans for this entirely avoidable health care catastrophe. The upcoming rate hikes are the result of the party’s failures to take health policy seriously for decades.
Republicans have failed to unify around a real plan
The Republican Party has been uninterested in health care reform for a long time.
When President Obama finally passed the Affordable Care Act in 2010, he did so without the GOP’s support — even though his plan incorporated policies, such as the individual mandate, that were originally proposed by conservative policy thinkers.
Ever since, the party has been focused singularly on dismantling it, rather than crafting a viable alternative to take its place. Their repeated pledges to repeal and replace the health care law ended in a disjointed and embarrassing failure in 2017. And, more recently, Trump himself could offer only “concepts of a plan” for health care during his second campaign for the presidency in 2024.
Since then, the White House surprisingly floated a plan to address the issue in late November, seemingly without vetting it with congressional Republicans, who quickly shut it down. Trump has otherwise been disengaged on the urgent issue of keeping health coverage affordable for millions of voters while simultaneously arguing that Americans’ concerns over affordability in general are a “hoax” (and building a $300 million White House ballroom).
On this specific question of the enhanced ACA subsidies, Republicans kicked the can down the road as much as they could — until they ran out of road.
They could have extended the assistance as part of the big, beautiful bill that passed this summer and done so in a way that would be more palatable to conservatives. But, according to Semafor, pressure from deficit hawks led the GOP to table the issue during the debate over that legislation. (Never mind that the overall bill, as passed, added more than $3 trillion to the deficit, even as it slashed Medicaid spending by $1 trillion, another move that could also lead to millions of Americans losing their health benefits.)
As even Republican strategists will acknowledge, GOP senators were only going through the motions of appearing to do something about the expiring subsidies. Their HSA plan was doomed to fail, and the party didn’t even unify around it until two days before the planned vote. This was not a serious effort to avert a huge premium increase for millions of their own constituents.
House Speaker Mike Johnson promised to advance several health care bills in the coming months, but congressional insiders are rightly skeptical.
The next great conservative health care plan has been just around the corner for more than a decade — “just in time,” in the words of Modern Healthcare deputy editor Jeff Young. It’s a joke that started in 2013. It’s still going today.
And, as today’s vote confirms, the Republicans appear no closer to coalescing around a real plan that would lower health care costs for the American people.
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