The office of Rep. Mike Flood (R-Nebraska) gets as many as 300 telephone calls a day. Lately, their congressman has been calling some back.
These are constituents who have left messages saying they get their health coverage through the Affordable Care Act exchanges and are worried about the soaring costs they will face when tax credits put in place during the coronavirus pandemic expire at the end of the month.
Those enhanced credits have spurred enrollment in the ACA marketplaces, which has more than doubled from about 11 million to more than 24 million people over the last five years. Some subsidies had already been available for households earning between 100 percent and 400 percent of the poverty line.
Flood is chairman of the House’s Main Street Caucus, which consists of more than 80 members who consider themselves “pragmatic conservatives.” He described in an interview the type of situation he keeps hearing.
“He’s 62, and she’s 64; she’s going to get on Medicare next year. Their premium right now is $2,200, and it’s going to $3,000,” Flood said. “$3,000 a month is obscene. That buys you the best house in Butler County, Nebraska.”
Pretty much every member of Congress can tell you stories like these, and that’s why the situation in which they find themselves is so perplexing. It’s doubly confounding given that “affordability” is what voters consider the top political issue going into a midterm election year. President Donald Trump owes his election to a second term in large part to concerns over the rising cost of living, a chief driver of which has been health care.
Three months ago, the Democrats’ battle to extend the expiring subsidies triggered the longest government shutdown in history. Yet the two parties are no closer to a deal on what to do about it.
Meanwhile, Trump is hardly engaging in the debate at all, beyond denouncing Obamacare as a “total disaster” and offering hazy statements, as he has for years, that he has “a concept of a plan” to replace it.
In the Senate, what many believed to be the last chance to do anything about it slipped away on Thursday, when lawmakers voted down both a Democratic proposal to extend the subsidies as well as a Republican one that would have instead given many Americans up to $1,500 in tax-free accounts to spend shopping for insurance.
There are still faint stirrings of life in the House, all of whose members will be on the ballot next year.
Speaker Mike Johnson (R-Louisiana) plans to bring a modest GOP health plan to the House floor for a vote this week. It would not extend the enhanced subsidies, but Johnson has indicated he will allow a separate vote on that question.
Sen. Angus King (I-Maine), who caucuses with the Democrats, is more optimistic than most in the wake of the failed Senate votes. “I think things are moving in the right direction. Sometimes you just have to test the waters on your preferred position, and then when that doesn’t work, you take the next steps,” he said in an interview.
The sticker shock will directly affect the tens of millions of Americans who take advantage of the subsidies. Most of them live in Republican-held congressional districts.
KFF has estimated that the expiration of the subsidies would more than double, on average, what people are paying annually. More than 4 million people would be likely to lose their health insurance entirely over the next decade, according to estimates from the nonpartisan Congressional Budget Office.
The effects, however, would go well beyond more Americans lacking affordable coverage. Many of the uninsured will show up in emergency rooms for care when sick. That will put even more burden on hospitals to provide uncompensated care. Many, particularly rural hospitals, are already financially shaky.
Demonizing everything about “Obamacare” has been a talking point of Republicans since before the Affordable Care Act was passed in 2010. But over the years, the law has actually become popular, with polls showing close to two-thirds of Americans have a favorable view of it.
And while Republicans claim the law has fueled soaring health care costs, studies have shown that the overall increase in health care spending as a share of gross domestic product has slowed since its passage.
The temporary subsidy arrangement, first passed in March 2021 as part of a covid-19 relief package, is not without flaws. A report this month by the Government Accountability Office found it susceptible to fraud. The GAO tested the system this year by creating 20 fictitious applicants; 18 of them were accepted.
Some also suggest there should be income limits on those who receive the enhanced subsidies. The current law has none, though in practice, few high earners spend a big enough percentage of their income on health care to qualify. Republicans also have objected to the fact that some participants spend nothing for their ACA policies, and argue that everyone in the program should be required to pay something.
Then there are larger questions, starting with: Why does the United States spend more on health care per capita than any other wealthy country but perform worse on outcomes such as life expectancy, infant mortality and unmanaged diabetes?
In that regard, Republicans contend, the ACA has not lived up to its promises.
“Democrats shut down the government because they wanted to force this issue on health care, and it did give an opportunity to educate about the real problems of the ACA,” said Brian Blase, president of Paragon Health Institute and an influential conservative voice on the issue. “It’s always easiest for politicians to kick the can down the road and just throw more taxpayer money at an issue, or more taxpayer money escalates the problems.”
Flood agrees that longer-term solutions are called for. In the meantime, he also would like to see Congress deal with the immediate financial crisis that his constituents are facing.
“Let’s do an extension so that we can work through this and not do this under a pressure-cooker situation. That’s the thing. Everybody’s got 15 different ideas, but we’re talking about something that’s super complex. It affects a lot of Americans, and we’re in a deadline situation,” Flood said.
Ironically, given the Republicans’ current paralysis on the issue, it was one of their own who was once considered the national trailblazer on health care reform.
Massachusetts’ governor in 2006, Mitt Romney, signed a law that made his state the first in the nation to guarantee health coverage for all. Some of its elements, including the establishment of state-run exchanges for people to buy coverage and subsidies to help lower-income enrollees afford it, were adopted nationally under the Affordable Care Act.
But the effort Romney put together was a bipartisan and nonideological one. It took more than three years to accomplish as he built a coalition behind solutions drawn from data and analysis.
“Why do politicians have such a hard time solving health care? Because it’s hard. There are no easy answers, despite the pledges from both sides of the aisle. And it’s expensive and getting more so every day,” Romney wrote me in an email last week.
He added: “I think it was H.L. Mencken who said that for every difficult problem there is an answer which is easy, clear and wrong.”
The post Rank-and-file Republicans feel heat from constituents on health care appeared first on Washington Post.
