Senate Heads Toward Health Care Votes  12/10 06:08

   The Senate is heading toward dueling partisan votes on health care this week 
after Republicans said Tuesday that they had united around a plan, for now, 
that would allow COVID-era health care subsidies to expire.

   WASHINGTON (AP) -- The Senate is heading toward dueling partisan votes on 
health care this week after Republicans said Tuesday that they had united 
around a plan, for now, that would allow COVID-era health care subsidies to 
expire.

   Both the Republican plan, which would replace the subsidies with new savings 
accounts, and a Democratic bill to extend the enhanced Affordable Care Act tax 
credits for three years lack the bipartisan support needed for passage. Senate 
Majority Leader John Thune, R-S.D., said Tuesday that the Democratic 
legislation does not include enough reforms to curb fraud or limit high-income 
recipients. That legislation "will fail," Thune said.

   At the same time, Democratic Leader Chuck Schumer called the Republican plan 
"phony" and said the bill is "dead on arrival."

   The burden is on Republicans "to vote with us," Schumer said of Democrats, 
who forced a 43-day government shutdown over the issue.

   With Republicans and Democrats unable to agree -- or even really negotiate 
with each other -- millions of people could see increases in their premium 
payments when the tax credits expire in January. Both sides blame the other for 
the increasingly likely failure of Congress to act, bringing the issue into the 
midterm election year with political talking points but little in the way of 
compromise on the subsidies that have helped keep costs down for many of the 
more than 24 million Americans.

   Tentative GOP unity after years of disagreement

   The Republican unity around a single plan, in the Senate at least, comes as 
the party has wrangled for more than a decade over how to replace former 
President Barack Obama's signature law, also known as Obamacare.

   The legislation by Louisiana Sen. Bill Cassidy, the chairman of the Senate 
Health, Labor, Education and Pensions Committee, and Idaho Sen. Mike Crapo, the 
chairman of the Senate Finance Committee, emerged this week from many different 
proposals from Republican senators, including some that would have extended the 
tax credits with new limits.

   Despite those differences, Republicans worked to project unity as they 
emerged from a lunch meeting Tuesday. Ohio Sen. Bernie Moreno, who had just 
recently proposed legislation to extend the subsidies with new income caps, 
said he is now "hyper-focused" on Cassidy and Crapo's legislation. Missouri 
Sen. Josh Hawley, who had his own bill to reduce taxes on health care, said the 
consensus bill "isn't perfect, but I'm willing to give it a go."

   "I just think that Republicans can't do nothing," Hawley said after the 
meeting. "I think we ought to be doing everything we can to try and get down 
the cost of health care."

   Thune said there will now be "something out there that Republicans will be 
able to talk about and support and vote for, and then we'll see."

   There was less consensus in the House, where moderate Republicans who are up 
for reelection have been pushing Speaker Mike Johnson, R-La., to extend the 
subsidies with new reforms while the right flank of the party has demanded 
deeper reforms to the ACA. House Majority Leader Steve Scalise told reporters 
that GOP leadership will present options to members on Wednesday for potential 
votes next week.

   Proposed health savings accounts

   The bill by Cassidy and Crapo would let the current subsidies, first put in 
place during the COVID-19 pandemic, expire. The legislation would then make 
payments to the new health savings accounts for the next two years, for 
enrollees making less than 700% of the federal poverty level who pick 
lower-cost, higher-deductible bronze or catastrophic health insurance plans.

   Eligible enrollees between the ages of 18 and 49 would get $1,000 per year, 
while those between 50 and 64 would get $1,500. The money could be spent to 
defray out-of-pocket expenses like copays and deductibles, or to purchase other 
qualified health-related items directly from companies, but not to cover 
monthly premiums.

   Cassidy and Crapo say their bill provides better support to Americans than 
the expiring subsidies do because it hands money directly to the people, giving 
them the power to decide how to spend or save it -- a message President Donald 
Trump has echoed in recent weeks. Republicans say the plan could also cut down 
on fraud in the health care system, pointing to a Government Accountability 
Office report that found some fake recipients were able to get coverage.

   The bill also includes new language limiting the use of Affordable Care Act 
money for abortion -- a dealbreaker for moderate Democrats who say they would 
have been willing to negotiate on the issue.

   Uncertainty over costs

   Health analysts warn that the plan won't do much to help lower-income 
Affordable Care Act enrollees who rely on subsidies to afford their monthly 
insurance fees.

   The Republicans' plan also requires enrollees to pick higher-deductible 
plans to be eligible for the payments -- meaning heavy users of health 
insurance may end up saddled with out-of-pocket costs far higher than the new 
influx of cash in their pockets.

   Oregon Sen. Ron Wyden, the top Democrat on the Senate Finance Committee, 
said the GOP proposal "leaves middle-class Americans saddled with sky-high 
premiums, and Big Insurance makes out like bandits by selling junk plans to 
families that desperately need health coverage."

   "Instead of working with Democrats to stop this health cost crisis, 
Republicans are selling snake oil," Wyden said.