WASHINGTON — As the U.S. careens to a health care cliff, Senate Republicans say they’ll offer a bill written by two key committee chairs as an alternative to extending billions of dollars in Affordable Care Act funds that are expiring this month.
Majority Leader John Thune, R-S.D., said the Senate will vote on a bill by Senate Finance Chair Mike Crapo, R-Idaho, and Senate HELP Chair Bill Cassidy, R-La., “side-by-side” to Democratic legislation that would extend the enhanced ACA funds for three years, preventing sharp premium increases.
He stopped short of promising that all 53 Republicans would back the Republican bill, but it is almost certain to fail either way, as it would take 60 votes to advance.
“Our members — and I can’t say 100%, but I think for the most part, I would argue — are united behind the Crapo-Cassidy proposal,” Thune told reporters Tuesday after a Senate Republican lunch meeting where they discussed what to do.
Thune said the bill “is about patients, not insurance companies; and about lowering premiums, not increasing them, and about getting a better return for the federal taxpayer.”
The Crapo-Cassidy bill would allow the ACA tax credits to expire and instead approve new funds to boost health savings accounts, or HSAs, which Americans up to 700% of the poverty level can use if they have “bronze” or “catastrophic” plans, the lowest tiers of insurance available under the ACA. It would also create the option for more people to buy those low-premium plans with less coverage and higher out-of-pocket costs. And it would fund cost-sharing reduction payments.
Eligible adults under 50 years old would get $1,000 per year deposited into an HSA, and those 50 to 64 would get $1,500. The legislation blocks using the money for abortion or “gender transition procedures.”
Democrats and some health care policy experts say that is nowhere near enough. If Congress allows the ACA subsidies to expire at the end of this year, premiums will double, on average, for more than 20 million Americans who use them.
Sabrina Corlette, a Georgetown professor who specializes in health care policy, said the Republican bill amounts to “offering people a 1-foot rope to get out of a 10-foot hole.”
“The average deductible for a bronze plan is $7,500, double that for a family plan,” she said. “The HSA contribution doesn’t extend to kids under 18 and is only $1,000 for an adult under 50. There’s no adjustment for income, meaning this proposal wildly favors wealthier — and healthier — enrollees.”
Senate Minority Leader Chuck Schumer, D-N.Y., slammed the Republican bill as a “phony proposal” and a “nonstarter” that is “dead on arrival” in the chamber.
He said the Crapo-Cassidy bill promotes “junk insurance” and would raise costs for those who need health care.
“It is junk insurance that puts the burden on people. We should call it what it is: misdirection, smoke and mirrors to cover up blocking the ACA tax credits that keep health care costs down,” Schumer told reporters. “Our bill keeps premiums down. Their chaos sends premiums up.”
Schumer has said all 47 Democratic caucus members will support his bill to extend the existing ACA premium tax credits for three years when it comes up on Thursday. In the House, every Democrat has signed a “discharge petition” to force a vote on the same bill; it would need the support of a majority of the House, meaning at least a few Republicans, to bring the bill to the floor.
Schumer added that stricter abortion restrictions, as GOP lawmakers have demanded as part of any deal, are “off the table.” He said Republicans are doing it because they’re “afraid” of the anti-abortion group SBA Pro-Life America and don’t “care about reducing health care costs.”
President Donald Trump stopped short of outright endorsing the Crapo-Cassidy bill when asked about it Tuesday on Air Force One, saying “I like the concept” and ripping into “Obamacare.”
Asked whether he wants Republicans to vote for the bill, Trump told reporters: “I love the idea of money going directly to the people, not to the insurance companies, going directly to the people. It can be in the health savings account; it can be a number of different ways.”
The Senate alternative comes as many Republicans — especially those facing re-election next year — are scrambling to get behind some kind of plan to address sharp premium hikes that are scheduled to kick in next month for millions of Americans. House GOP leaders have not endorsed a health care alternative.
Sen. Josh Hawley, R-Mo., warned that Americans will blame Republicans if their premiums skyrocket at the end of the month.
“I just don’t know how Republicans would explain that to 24 million Americans whose premiums are going to double,” Hawley said. “People at home are going to say, 'You are hurting me. You’re making my premiums go up. You’re not helping me. Why are you doing that to me?'”
And Sen. Thom Tillis, R-N.C., said he heard from a constituent who’s “currently paying $800 a month for health insurance, for a couple and three children.”
“They just communicated to me, it’s going to be twice, going to be $1,600 a month. If we’ve got a lot of those out there, that’s a problem for us,” said Tillis, who is retiring. “Look, the Democrats created the problem. We’ve got to solve it, or going into next year, we will own a problem that they created.”
Republicans have offered a potpourri of other proposals to ease the pain. Some are merely frameworks. Others have been written out into legislative text. Some offer a temporary extension of the money, with strings attached, like narrowing income thresholds for eligibility, requiring a minimum premium payment and slapping new abortion restrictions.
But none of the Republican plans to prevent ACA funds from expiring have consensus in the party, as many GOP lawmakers in both chambers want the money to expire on schedule.
“Giving billions of taxpayer dollars to insurers is not working to reduce health insurance premiums for patients,” Crapo said. “We need to give Americans more control over their own health care decisions. This bill builds on the work we did in the Working Families Tax Cuts Act and will help Americans manage the rising cost of health care without driving costs even higher.”
Larry Levitt, a health policy expert with the research group KFF, highlighted the “tradeoffs” in the GOP proposal, saying it would benefit healthier people while raising costs on sicker people.
“The increase in premium payments for ACA enrollees would be cushioned to some extent by federal contributions to health savings accounts. People who are healthy could be better off under the Republican plan, using their health savings accounts to cover routine health expenses,” he said. “ACA enrollees who are sick would be stuck with big out-of-pocket premium increases or have to switch to a plan with a deductible of over $7,000. People with substantial health needs would blow through their modest health savings accounts and face big, out-of-pocket costs.”
“The Republican plan would not avoid ACA enrollees seeing their out-of-pocket premiums doubling next year,” Levitt added.
As many members of Congress have acknowledged, the premium hikes are likely to go into effect. Both the Democratic and Republican bills are expected to fail this week on the Senate floor, where they’ll need 60 votes to advance.
Sen. Lindsey Graham, R-S.C., said he has little interest in extending money under the ACA, calling it “a program that’s just never going to produce quality results.”
“I’d like to make drugs more affordable,” he said. “So how do you do that? You change the system that makes them too high.”
