Competing health care plans fail in the Senate as ACA premium hikes loom

Subsidies for the Affordable Care Act appear set to expire for millions of Americans at the end of the year after competing health care related bills failed to advance in the Senate on Thursday.

The outcome was widely expected after Democrats and Republicans chose to release separate partisan proposals. Both parties are under pressure to address health care costs before the expiration of federal subsidies meant to lower the cost of premiums on ACA plans. Those subsidies expire at the end of 2025 and are expected to cause prices to skyrocket.

Both bills needed 60 votes to advance, but neither succeeded.

The Republican-backed plan failed by a vote of 51 to 48. The measure, authored by Bill Cassidy, R-La., and Mike Crapo, R-Idaho, would have provided up to $1,500 a year in payments for health savings accounts for Americans earning less than 700% of the federal poverty level.

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However the bill would not have extended the ACA tax credits and the money could not be used to pay for health care premiums. Deductibles for those plans average around $7,000, according to data from the health policy organization KFF.

Democrats rejected the bill arguing it did nothing to address health care premiums, and opposed restrictions in the bill on abortion and gender affirming care.

"The Republican plan is a when you get sick, you go broke plan plain and simple," Senate Minority Leader Chuck Schumer, D-NY, said ahead of the vote.

In a trade-off to reopen the government following the longest shutdown in U.S. history, Senate Republicans promised Democrats a vote on a bill of their choosing to extend the subsidies. Democrats proposed a three-year extension of existing federal subsidies, but that measure failed 51 to 48. Four Republicans joined with Democrats: Susan Collins of Maine, Missouri's Josh Hawley, and Lisa Murkowski and Dan Sullivan of Alaska.

Republicans have argued that extending the subsidies would allow what they describe as Obamacare "waste, fraud and abuse" to continue, while lining the pockets of insurance companies.

"There is nothing in their [Democrats] bill that stops billions of dollars in fraudulent spending," Cassidy said on the Senate floor Wednesday.

The failed votes on Thursday left the future of the ACA subsidies even further in doubt. GOP leaders in the House are signaling a potential vote in coming days on legislation to address health care costs, but the party has yet to coalesce behind a plan.

Speaking to reporters on Wednesday, Majority Leader Steve Scalise, R-La., said that starting next week, the House would begin voting "on bills that will focus on lowering premiums for 100% of Americans."

"Let's see where Democrats stand when its not just giving money to insurance companies and propping up failed Obamacare plans," Scalise said.

The fight over the subsidies has once again exposed a split inside the GOP over how to control rising healthcare costs — a debate that has snarled the party since the ACA first passed in 2010.

While some Republicans say they are prepared to watch the subsidies lapse, others have joined with Democrats to press for an extension. In the House, Rep. Brian Fitzpatrick, R-Pa., has partnered with Jared Golden, D-Maine, on a plan to extend the credits for two years while imposing new eligibility requirements. A separate plan from Rep. Jen Kiggans, R-Va., and Josh Gottheimer, D-N.J., would extend the subsidies for one year. The bill has more than a dozen Republican cosponsors.

Both proposals were filed through a rare legislative tactic known as a discharge petition — a workaround that lets members force a vote without the approval of leadership or committees if they can first secure 218 signatures in support.

For his part, President Trump has largely remained hands off. He has been sharply critical of the ACA subsidies, and while he has not endorsed a specific proposal he has voiced support for sending money directly to Americans to pay for care.