The House and Senate closed their doors on Thursday, leaving the fate of the Affordable Care Act’s subsidies hanging in the balance as premiums for roughly 22 million Americans are set to climb next month.
House and Senate Adjourn
Both chambers adjourned for the holiday season, with no agreement on how to keep the enhanced subsidies from expiring. The decision means that, by the start of 2024, insurance premiums for about 22 million people will rise.
Republican Opposition
House Speaker Mike Johnson, R-La., and Senate Majority Leader John Thune, R-S.D., publicly opposed any extension. They argued that the current subsidies should not be prolonged without reforms. Their stance has created a stalemate that the two chambers could not break.
Democrats’ Resolve
In contrast, Democrats are determined to use the issue as a political weapon in the upcoming 2024 midterms. Rep. Pat Ryan, D-N.Y., voiced frustration: “They are absolutely screwing over millions of people, including my constituents, which pisses me off,” said Rep. Pat Ryan, D-N.Y. “It’s just pathetic. The last time there was a major national Republican effort to repeal the ACA, we had an overwhelming wave where they got absolutely wiped out, and I think that’s likely what will happen here again.”
Bipartisan Discharge Petition
Despite the split, four swing-district Republicans-Brian Fitzpatrick, Rob Bresnahan, Ryan Mackenzie of Pennsylvania, and Mike Lawler of New York-joined 214 Democrats to file a discharge petition. The goal is to force a vote on a three-year extension of ACA funds. The House is expected to take the measure in the week of Jan. 5 when it reconvenes.
Lawler expressed optimism on NBC’s “Meet The Press Now”: “I do believe if the bill comes to the floor, not only will it pass, but it’ll give the Senate the ability to come back with a bipartisan compromise and actually get something passed into law,” Lawler said Wednesday.
Republican Bills and Their Fate
Both chambers passed Republican-led bills that incorporate conservative ideas but do not restore or replace the ACA funds. The House version was adopted on Wednesday, but analysts say it is unlikely to become law. Rep. Madeleine Dean, D-Pa., warned that swing-district voters are seeing the political cost: “I was literally in Mr. Bresnahan’s district on Saturday at a town hall attended by more than 200 people,” she said. “They all know that he went against them with the ‘big, beautiful bill’ vote on the Medicaid cuts. And so they got the message. They’re in trouble.”
Senate Reactions
Numerous Republican senators told NBC News that the House bill is dead on arrival across the Capitol. Retiring Sen. Thom Tillis, R-N.C., an early proponent of extending the funding who opposes a full three-year extension absent reforms, said: “There’s no way it’s going to sail through.” He added, “I would expect the vote count if it were just purely this wouldn’t be probably the same as it was last week.”
The Senate’s own attempt to extend the ACA funds failed on Thursday with a 51-48 vote. Four Republicans joined Democrats, falling short of the 60 votes required to break a filibuster.
Centrist Senators’ Stance
Sen. Susan Collins, R-Maine, who has long broken with her party on ACA matters, declined to endorse the House bill even if it passed. She told NBC News, “What we’re trying to do is to put together a bipartisan bill that would have reforms plus a two-year extension.” She added, “That is the best approach, in my opinion, and we’re making good progress.” She noted that House passage would keep momentum going but said, “I think we need a bill that also has some reforms, such as an income cap, to just give you an example.”
Sen. Lisa Murkowski, R-Alaska, said the House bill is unlikely to clear the Senate but could serve as a vehicle for a bipartisan deal. “It’s too late to avoid the shock factor, but it’s not too late to do something about it,” Murkowski said. “And so I refuse to be in the camp that says, well, you just have to give it up then.”
Republican Senators’ Concerns
Sen. Jim Justice, R-W.Va., warned that an expiration would hurt his constituents. “We’ve got to give people an exit ramp. My proposal was: do 90% now, 60% in a year, 30% in the year, and then it wouldn’t be too easy, too difficult to step away from it,” Justice said. He added that Republicans must recognize the financial pain Americans would feel if the money simply dried up. “They better. Honest to God, they better,” he said. “If they don’t, they’re living in a cave.”
Sen. Mike Rounds, R-S.D., highlighted a key stumbling block: “There’s people working on it,” Rounds said, while adding that he’s not sure if they’ll find a way to resolve the issue. The dispute centers on “Hyde” language, which would tie abortion restrictions to Obamacare money.
Leadership Comments
Thune demurred on what the Senate would do if the House’s three-year funding bill passes: “We’ll cross that bridge when we come to it.” Senate Minority Leader Chuck Schumer, D-N.Y., warned that after Jan. 1, when higher premiums kick in, it will be “very hard to put that toothpaste back in the tube.”
Democrats’ Tactics
Democrats indicated they will not try to link ACA funding to the Jan. 30 deadline that previously forced a 43-day shutdown. Sen. Jeanne Shaheen, D-N.H., who voted to reopen the government, said, “I don’t see that,” adding, “That’s just me.”
Sen. Josh Hawley, R-Mo., one of four GOP senators who voted to advance an ACA funding extension, urged Republicans to move past their 15-year feud. “People want us to do something to help them with the costs,” he said. “And I don’t think they really care about who voted for what 20 years ago. They care about their health care costs going up.”
Key Takeaways
- The House and Senate adjourned without a plan to extend ACA subsidies, risking higher premiums for 22 million Americans.
- A bipartisan discharge petition seeks to force a vote on a three-year extension, expected in the week of Jan. 5.
- Senate and House Republicans have passed bills that do not restore ACA funds, and the Senate’s own extension failed 51-48.
The debate continues as lawmakers weigh the political costs of leaving millions without subsidies against the desire for reforms. The outcome will shape the Affordable Care Act’s future and the 2024 election landscape.
