Chances Dwindle for Med Subsidy Renewal12/03 06:18

   

   WASHINGTON (AP) -- Hopes for an extension of health care subsidies were 
diminishing in Congress this week as Republicans and Democrats largely 
abandoned the idea of bipartisan talks on the issue, increasing the odds that 
millions of Americans could see sharp premium spikes starting Jan. 1.

   Democrats who agreed earlier this month to reopen the government in exchange 
for a December health care vote were hoping they could work with Republicans to 
extend the COVID-era Affordable Care Act tax credits that help many Americans 
pay for their health coverage. But lawmakers in both parties have spent most of 
the time since talking amongst themselves instead, while rehashing longstanding 
partisan arguments over the law in public.

   "I don't think at this point we have a clear path forward, I don't think the 
Democrats have a clear path forward," Senate Majority Leader John Thune said 
Tuesday after Republicans met and discussed different proposals to overhaul the 
law.

   The impasse means the Senate vote, expected next week, could be a party-line 
messaging exercise with no real chance of passage. Under the deal struck to end 
the shutdown, Democrats can determine the legislation that comes up for a vote. 
But Senate Democratic Leader Chuck Schumer has indicated they are leaning 
toward a vote on a straight extension of the subsidies with no new limits or 
tweaks to the law, which Republicans have already rejected.

   "So far the Republicans are in total disarray and have no plan," Schumer 
said Tuesday. "We have a plan."

   Democrats say they are willing to negotiate on the issue, and some have said 
they would be open to new limits on the subsidies. But they argue that two main 
issues are holding up talks: the lack of input from President Donald Trump, and 
Republicans' insistence that abortion funding be part of the discussion.

   "Our Republican colleagues aren't going to engage with us" unless Trump 
weighs in, said Sen. Peter Welch, D-Vt. "That's the paralysis here."

   Abortion issue holds up compromise

   Maine Sen. Angus King, an independent who caucuses with the Democrats, was 
part of the group that struck a deal to end the shutdown. He says there have 
been some informal bipartisan discussions since then, but says they stalled as 
Republicans insisted on stricter abortion restrictions on Affordable Care Act 
plans.

   "They have set up a red line that is also a red line for the Democrats," 
King said of Republicans. "So they're going to own these increases."

   Missouri Sen. Josh Hawley, who has said he wants to see the tax credits 
extended, said the issue "should not be a deal-killer" since a ban on federal 
funding for abortions is already in the law.

   Democrats say current law should be sufficient. While many states ban 
abortion coverage from all plans in the ACA marketplaces, others allow or 
require abortion coverage that isn't paid for with federal funding.

   Republicans weigh different plans

   Beyond the abortion issue, many Republicans have said for years that they 
want to see the ACA scrapped or overhauled. But there is still little consensus 
in the GOP about whether to do that or how.

   Republican senators have discussed several competing proposals in recent 
weeks. Louisiana Sen. Bill Cassidy and Florida Sen. Rick Scott have suggested 
creating different types of health savings accounts that would change the way 
people buy insurance -- an idea that Trump has endorsed in social media posts 
without much detail. Other senators have suggested extending the subsidies with 
new limits on income.

   Thune said Tuesday that "we will see where the Republicans come down, but 
that conversation continues."

   Republicans want to work on a constructive solution, he said, "but that 
hasn't landed yet."

   In the House lawmakers were also discussing different ideas. But there was 
no indication that any of them could be ready by the end of the year or 
generate enough bipartisan support.

   "Health care is a very complicated issue," House Speaker Mike Johnson, 
R-La., said Tuesday, while insisting that Republicans were still "pulling ideas 
together."

   Trump gives little guidance

   Lawmakers in both parties have said it will be hard to move forward without 
Trump's support for a plan. But the president has yet to formally endorse any 
legislation.

   Last week, the White House circulated a proposal to extend the subsidies 
with some limits, like new income caps and a requirement that all recipients 
pay some sort of premium. The proposal would also have allowed those in 
lower-tier plans, such as the bronze-level or catastrophic plans, to put money 
into health savings accounts.

   But the proposal was never released.

   Asked last week whether he wants to extend the subsidies, Trump appeared to 
refer to the leaked plan, saying that "somebody said I wanted to extend it for 
two years. ... I'd rather not extend them at all."

   Still, he acknowledged that some sort of extension may be "necessary."