The Senate was on track Thursday to block two competing proposals to avert rising health care premiums, with back-to-back floor votes that were expected to highlight a partisan deadlock on the issue.
Democrats, who demanded action on the issue during the 43-day government shutdown, were pressing for a three-year extension of expanded Affordable Care Act insurance subsidies that are slated to expire at the end of the year. Republicans were proposing to allow the tax credits to expire and replace them with an expansion of tax-advantaged health savings accounts and direct payments of up to $1,500 to people who buy the most basic health insurance plans.
Neither proposal was expected to draw the 60 votes necessary to advance in the Senate, making it likely that the tax subsidies for health coverage under the Affordable Care Act will expire at the end of the month.
With Congress set to leave for the holidays next week and the two sides still far apart on their approach to rising health insurance costs, time was nearly out to renew the premium subsidies, causing a sharp increase in costs for millions of Americans who buy coverage on the federal health care exchange. The stalemate is likely to figure as a central issue in the upcoming midterm election campaigns as Democrats see an opening to pound Republicans for failing to head off premium increases and threatening health care access.
Republicans said that the Democratic approach would simply maintain a “bloated” federal program that was meant to be temporary and is experiencing unsustainable costs. They said a new Government Accountability Office investigation also found the program is susceptible to fraud that has contributed to insurance company profits.
“The Democrat proposal, which is a three-year extension of the status quo, is an attempt to disguise the real impact of Obamacare’s spiraling health care costs,” said Senator John Thune, Republican of South Dakota and the majority leader. “If we extend this three years at a cost of $83 billion to the taxpayers, what happens after three years?”
Democrats said that the Republican proposal amounted to an inadequate “coupon” for health care, noting that it would only go to those who purchased high-deductible insurance plans that require people to pay thousands of dollars for medical care before receiving coverage. They argued it would do nothing to head off the immediate threat of rising premiums.
“What Republicans have put forward is a not a health care plan,” said Senator Patty Murray, Democrat of Washington. “It is a sick joke.”
Republicans had committed to allowing Democrats a vote on their proposal to extend the health care subsidies as a condition of a deal to end the government shutdown. The G.O.P. had considered not offering an alternative to the Democratic proposal, but party leaders faced pressure to put a plan forward so Republicans could say they had some alternative to allowing the tax subsidies to expire.
House Republicans say that next week they would begin considering some piecemeal measures that represent their approach to addressing rising health care costs, but an extension of the subsidies are so far not part of the mix. As a result, a group of House Republicans worried about the political backlash from allowing the subsidies to expire started a petition on Wednesday to try to force a floor vote.
The White House has taken a largely hands-off approach to the congressional health care fight. President Trump initially suggested he would back a limited extension of the subsidies but was quickly urged by Republicans on Capitol Hill to drop that push.
Carl Hulse is the chief Washington correspondent for The Times, primarily writing about Congress and national political races and issues. He has nearly four decades of experience reporting in the nation’s capital.
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