Republicans Engage in Do-Or-Die Health Care Push

In a short timeframe, Republicans in Congress are attempting to legislate on an issue that has challenged them for over a decade—health care.

At the end of the year, President Joe Biden’s COVID era boosts to premium tax credits are set to expire. Democrat messaging on the issue has repeatedly accused Republicans of taking away Americans’ health insurance, putting pressure on Republicans to act before year’s end.

Now, Republicans are scrambling to present an alternative to the tax credits—which they say more closely resemble direct subsidies to insurance companies, are vulnerable to widespread fraud, and have produced market distortions and inflation.

The Senate‘s Menu of Options

Thursday is set tobe a tremendously important day for this health care fight as Senators will have the option of advancing two bills. 

One is the Democratic proposal to simply extend the enhanced credits for three years. 

The other is the Republican-backed overhaul from Sens. Bill Cassidy of Louisiana and Mike Crapo of Idaho, which would allow the credits to expire. 

There had been other Republican proposals to choose from, such as Sen. Rick Scott of Florida’s bill, a somewhat similar proposal which would allow states to opt out of more elements of Obamacare, enabled consumers to shop across state lines for plans.

It additionally would reinforce President Donald Trump’s 2019 health care price transparency executive order. Rep. August Pfluger, R-Texas, has introduced companion legislation in the House.

Cassidy and Crapo’s bill would put in place of premium tax credits new health savings accounts that would have funds deposited by the Department of Human Health and Services (HHS). The funds could not be used for abortion or gender transition procedures.

Additionally, the Cassidy-Crapo bill would widen plan options for consumers and include provisions to prevent taxpayer funds from going to illegal immigrants and transgender procedures.

“This program desperately needs to be reformed, the Democrats have decided, ‘We’re not going to do anything to reform it,’ and so we’ll see where the votes are on Thursday,” Senate Majority Leader John Thune, R-S.D., said at a Tuesday press conference. “But we will have an alternative that we will put up that reflects the views of the Republicans here in the United States Senate.” 

Neither bill is likely to get the 60 votes necessary to be advanced to a vote on a floor, as Senate Minority Leader Chuck Schumer, D-N.Y., has already expressed his opposition to the Cassidy bill, but Thursday’s floor action is a chance to get the ball rolling on health care legislation.

Sen. Josh Hawley, R-Mo., told reporters Tuesday that what has to come after the likely standstill is good faith negotiation from both sides.

“Hiopefully further negotiation” comes next, he said, “so we can get to some sort of a compromise that can get 60 votes.”

A House Divided

In the House, where some Republican rank-and-file have recently complained about the chamber not being in the driver’s seat of policy creation, leadership has not yet unveiled its exact proposals.

 However, Speaker of the House Mike Johnson, R-La., confirmed Wednesday that he would be advancing a package to tackle the issue. 

The Republican conference is split between numerous views on the matter, with some advocating an extension of existing subsidies, and others advocating their complete overhaul.

“Some are talking about that,” House Majority Leader Steve Scalise, R-La., told reporters when asked if his some of his members favored a short-term extension of the subsidies. House Republicans had held their weekly conference meeting Wednesday morning.

“But there were members on the other side of that issue as well,” Scalise said. “And again, when you got a very narrow majority, if less than a handful of members are on the other side of an issue, it’s not going to make it through our conference.”

Republican members of the House ways and means Committee—a key committee dealing with taxation issues—indicated that they would not be able to stomach a proposal which would simply extend the Obamacare credits as they left the conference meeting.

“This is absolutely destroying the health care system,” Rep. Greg Murphy, R-N.C., said of the credits system. “The CEOs are making 80, 100 million dollars a year while a family of four can’t afford their premiums.”

Rep. Jason Smith, R-Mo., who chairs ways and means, told reporters that he will not go along with a health care plan tailored to credit recipients—who, although numerous, are only a subsection of the wider American population.

The recipients are, in accordance with the eligibility structure of the program, generally people under 65 who do not receive insurance coverage from an employer but are also not impoverished enough to receive Medicaid.

“Options on healthcare have to be focused on lowering the cost and premiums for every single American, not just the ones on exchanges,” Smith told reporters in a heated tone. “And so I’m glad that people are started to have that discussion and putting the timeframe on when things happen. That’s up to leadership to decide, but I will not support policies that don’t lower healthcare costs for all America”

The Abortion Angle

A number of pro-life provisions in GOP healthcare proposals are under pressure because of Democrat opposition.

While this opposition does not matter much in the House, Democrats will ultimately need to vote with Republicans on a healthcare package to overcome the upper chamber’s filibuster.

Speaker Johnson made clear that House Republican proposals will include pro-life provisions in response to a question from The Daily Signal on Wednesday.

“Look, it’s an important principle. The Republicans always stand by the Hyde provisions,” Johnson told The Daily Signal on Wednesday. “It’s been a tradition in our law forever. We do believe in the sanctity of human life and we think it’s important that taxpayer dollars not fund abortion. This is a well settled principle of ours.”

Rep. Greg Murphy, R-N.C., told reporters that abortion, specifically the issue of whether to include a pro-life “Hyde” provision to the package, is causing issued in the House.

“The real problem is the Hyde amendment issue, and I would urge that our groups that support us look at the big picture here. We either have incremental wins or we lose everything,” Murphy said.

Asked if he meant incremental wins should be sought specifically on pro-life issues, Murphy told The Daily Signal, “Well, that’s part of it, but also, we can do about 15 things, really, that lower the cost of care in the United States… The whole insurance industry in the United States is something that is not replicated across the entire world. It’s an aberration, and it absolutely needs complete reform.”

A Do-Or-Die Situation

There is a growing Republican consensus that they must act decisively on health care and insurance policy quickly, or Democrats will take the reins on the matter.

“If we play small, we’ll lose the elections,” Rep. Josh Brecheen, R-Okla., said. “We have to do overhaul of this engine that is sputtering, of the unaffordability among health care.”

House Minority Leader Hakeem Jeffries is already attempting to sow dissent in the Republican caucus, having filed a discharge petition which, if it gathered enough Republican signatures, would force a vote on his bill to extend the subsidies for three years.

There also appear to be Republican-led efforts to circumvent leadership. Punchbowl News reported Wednesday afternoon that moderate House Republicans are filing a discharge petition to force a vote on Democrat Rep. Jared Golden of Maine and Republican Rep. Brian Fitzpatrick of Pennsylvania’s bill to extend the subsidies for two years.

With midterms approaching, Democrats attempting to stoke the fires of dissent, and Republicans eager to fight back, it appears vital for House Republican Leadership to deliver on popular health care legislation.

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