Johnson Declines to Extend Health Care 12/17 06:13

   House Republican leaders are determined to push ahead with a GOP health care 
bill that excludes efforts to address the soaring monthly premiums millions of 
Americans will soon endure as pandemic-era tax credits for people who buy 
insurance through the Affordable Care Act expire at year's end.

   WASHINGTON (AP) -- House Republican leaders are determined to push ahead 
with a GOP health care bill that excludes efforts to address the soaring 
monthly premiums millions of Americans will soon endure as pandemic-era tax 
credits for people who buy insurance through the Affordable Care Act expire at 
year's end.

   Speaker Mike Johnson had discussed the prospect of allowing more politically 
vulnerable GOP lawmakers a chance to vote on their amendment that would 
temporarily extend pandemic-era subsidies for ACA coverage. But after days of 
private talks, leadership sided with the more conservative wing of the 
conference, which has assailed the subsidies as propping up a failed ACA 
marketplace.

   "We looked for a way to try to allow for that pressure release valve," 
Johnson said Tuesday at the Capitol. "In the end, it was not -- an agreement 
wasn't made."

   The maneuvering surrounding the health care vote all but guarantees that 
many Americans will see substantially higher insurance costs in 2026. In the 
Senate, a bipartisan group was still trying to come up with a compromise to 
extend the subsidies, which fueled this year's government shutdown. But 
senators made clear that any potential legislation would likely wait until 
January, after the holiday break.

   Instead, House Republicans will pursue their 100-plus-page health care 
package that focuses on long-sought GOP proposals designed to expand insurance 
coverage options for small businesses and the self-employed. A test vote is 
expected Wednesday.

   The Republicans' package would clamp down on middlemen called pharmacy 
benefit managers who work to manage drug costs and process claims for insurance 
plans. The bill would also expand access to what's referred to as association 
health plans, which would allow more small businesses and self-employed 
individuals to band together and purchase health coverage.

   An analysis from the nonpartisan Congressional Budget Office and the Joint 
Committee on Taxation estimates the package would decrease the number of people 
with health insurance by an average of 100,000 per year over a 2027-2035 
window, while reducing the federal deficit by $35.6 billion.

   Failing to address expiring insurance subsidies 'political malpractice'

   Rep. Mike Lawler, R-N.Y., blasted the leadership's decision to not allow for 
a vote to temporarily extend the health insurance subsidies, saying it amounted 
to "political malpractice."

   Lawler, who hails from a competitive district, noted that most people who 
get their health coverage through the Affordable Care Act live in states that 
President Donald Trump won and said the changes proposed for a temporary 
extension were "conservative reforms." He also criticized Democratic leader 
Hakeem Jeffries for not pushing Democrats to support a pair of bipartisan 
extension efforts.

   "You have two leaders who are not serious about solving this problem," 
Lawler said of Johnson and Jeffries.

   Still, the centrist Republicans indicated they would not try to block the 
Republican leadership's measure from coming to a vote.

   Johnson defended the House GOP's bill, which includes priorities that 
Republicans have been working on for several years.

   "We have a long list of things that we know will reduce premiums, increase 
access and quality of care," Johnson said. "The Democrats have zero ideas, zero 
concepts and zero legislative plans on anything they'll propose other than just 
subsidizing the broken system."

   Democrats said even if the bill passes the House, it will not pass the 
Senate, where it would need 60 votes and bipartisan support to advance. They 
said it was not a serious effort to address rising costs.

   "Millions will be priced out of their coverage, and those who can still 
afford it will get less while paying more," said Rep. Suzan DelBene, chair of 
the House Democratic campaign arm. "Republicans are ignoring the pain, the pain 
we're seeing across the country for everyday Americans. And make no mistake, it 
is going to cost them the majority."

   GOP bill focuses on insurance options and cost-sharing

   During Trump's first term, his administration sought to expand access to 
association health plans that don't have to offer the full menu of benefits 
required under current law. The option offers lower premiums for small 
businesses and self-employed people, but the policies are likely to cover fewer 
benefits. A federal judge who struck down the administration's effort in 2018 
said the plans were were "clearly an end-run" around consumer protections 
required by the Affordable Care Act, also known as Obamacare.

   The House Republican plan would also restore government funding for 
cost-sharing reductions, or CSRs, a type of financial help that insurers give 
to low-income ACA enrollees on silver-level plans that reduces their share of 
costs like deductibles and copays.

   From 2014 until 2017, the federal government reimbursed insurance companies 
for CSRs -- but in 2017, the Trump administration stopped making those 
payments. To make up for the lost funds, insurance companies hiked premiums for 
silver-level plans -- a complicated move that ended up increasing the financial 
assistance many enrollees get to help pay for premiums.

   As a result, health analysts say that while restoring funding for CSRs would 
likely bring down silver-level premiums, it could also have the unwelcome 
ripple effect of increasing many people's net premiums on bronze and gold plans.

   The provisions related to pharmacy benefit managers require the middlemen to 
disclose certain data about their operations to group health plans, with the 
hope that more transparency would reduce prescription drug costs.

   Senators revive talks of action in the new year

   Almost two dozen Republicans and Democrats met late Monday to talk about a 
last-minute fix on the ACA tax credits after the Senate rejected two partisan 
health care bills last week. They emerged from the meeting discussing ways to 
end the stalemate, including a possible two-year extension of the subsidies 
with reforms that would narrow who could receive them. They also discussed 
adding some version of a GOP proposal to create new health savings accounts 
that would help people purchase insurance.

   Maine Sen. Susan Collins, a Republican who led the bipartisan meeting, said 
the group would like to announce a proposal this week. But there were still 
significant unresolved issues, including whether to include stricter language 
on abortion funding. Disagreements over abortion were one of the main sticking 
points in earlier talks that derailed a compromise.

   Senate Majority Leader John Thune said there's a "potential pathway" to an 
agreement in January, but acknowledged, "we're not going to pass anything by 
the end of this week."