GOP Chooses to Ignore Reality, Let Obamacare Costs Skyrocket

When a few Senate Democrats voted to end the longest government shutdown in history last month, the one concession they secured from Republican leader John Thune was a mid-December vote on a measure to extend expiring Obamacare premium subsidies. The vote is now supposed to happen later this week amid general acknowledgment that without action on the subsidies, both premiums and out-of-pocket costs for over 20 million Americans are going to skyrocket in January.

This will be a much bigger problem for Republicans than for Democrats, for three reasons: (1) Democrats have been hyperventilating over this “subsidy cliff” for months, placing it at the very center of their shutdown strategy; (2) it’s part of a more general health-care policy landscape in which the GOP is widely perceived as either feckless or cruel; and (3) Republicans run the entire federal government, and their leader, Donald Trump, dominates political discourse 24/7.

Yet Republicans are very likely to pass up the opportunity to do anything about this situation other than agitate the air and shift blame. The original Thune strategy was to put up competing Democratic and Republican “solutions” to the subsidy cliff and see if either could pass (very unlikely given the need for 60 votes to do anything in the Senate), or if, perhaps, a compromise might emerge. Now the big question is whether Republicans can come up with anything that would even merit a vote.

The leading candidate for a vote is a proposal being hashed together by Republicans Mike Crapo and Bill Cassidy featuring an assortment of ancient Republican health-care panaceas, mostly focused on beefing up health savings accounts and encouraging small-business risk pools. It would not include any, even for one day, extension of Obamacare subsidies. In the House, a vote on a similar Republicans-only bill is possible, but Mike Johnson hasn’t promised anything at all. And, of course, even if Republicans in either chamber or both chambers agreed on some health-care policy, it couldn’t pass the Senate without some Democratic support, and that simply isn’t happening without some sort of Obamacare subsidy extension.

So where we are headed is a lot of talk but no action by Congress. There is a screamingly obvious bipartisan patch that could get to 60 Senate votes — so obvious, in fact, that Donald Trump himself apparently was on the brink of proposing it before angry House conservatives objected: a limited Obamacare subsidy extension with a couple of Republican-proposed “reforms” limiting eligibility and requiring minimum buy-in, along with a “down payment” on some sort of long-term GOP alternative focused on HSAs and other individual health-care subsidies. A little of this, a little of that, with both parties agreeing to defer the ultimate battle over health-care policy until after the midterms or after the next presidential election.

That apparently won’t happen because Republicans generally and Trump in particular have retreated to the pre-Obamacare ground of objecting to anything that would prohibit price discrimination against older and sicker Americans, or indeed that would guarantee access to health care beyond whatever individuals or their employers could negotiate. Indeed, listening to Trump lately, he seems to long for the days before health insurance was a thing and rugged individuals just paid their doctor and hospital bills with maybe some government money but no other involvement. Here’s what he told Politico this week:

What I want on health care is very simple. Uh, Obamacare was set up for insurance companies to become rich, OK? That was why they … in my opinion, I think the Democrats did it for that reason … I don’t want to pay ’em anything. No money for the insurance companies. Sorry, fellas. I know ’em all. No money for the insurance companies. I want to pay the money directly to the people and let the people get their own health care.

Spoken like someone from the American Medical Association circa 1959. There are two problems with this bizarre GOP retreat from engagement with reality. The first is that Obamacare and the enhanced subsidies Democrats made available to pay for the premiums are more popular than ever. A new survey from Morning Consult shows voters favoring extension of the Obamacare subsidies by nearly a three-to-one margin; Republican voters favor it by a 10 percent margin. If Trump and his party wanted to develop and sell a conservative alternative to Obamacare, they’ve had a decade to do so; their inability to find their butts with both hands on this topic has been a running joke for years and years. Now it’s unclear they can even articulate and agree upon a health-care proposal for a “messaging vote” that everyone knows will never become law. And that’s with the GOP already burdened with the Medicaid and Obamacare cuts they did manage to enact in Trump’s beloved One Big Beautiful Bill Act.

There’s still a possibility the ever-erratic 47th president will reverse himself yet again and impose on his restive troops a compromise that heads off the Obamacare subsidy cliff and buys time to come up with something more substantive than bitching about Barack Obama and his signature health-care initiative. But even then, the redoubled opposition of the anti-abortion movement to any legislation affecting Obamacare that doesn’t ban even the most indirect coverage of abortion services could make it a bridge too far.

So if you’re affected by Obamacare premium subsidies, don’t expect any help from the 119th Congress. Perhaps when Congress reconvenes and faces another potential government shutdown on January 30, Republicans will seize a last opportunity to avoid an explosion of health-care costs. But right now, they seem to be standing pat and looking for excuses to do nothing.