House Passes GOP Health Bill Without Subsidies

House Republicans on Wednesday passed a partisan package of health care policies designed to provide a conservative alternative to extending the expiring ObamaCare subsidies.

The legislation has little chance of passing through the Senate, however, and it does not address the cost cliff that’s expected to hit 22 million Americans when the enhanced Affordable Care Act (ACA) tax credits sunset on Dec. 31 — a dynamic that’s infuriated centrist Republicans who’ve clamored for months to extend the benefits.

Still, even the frustrated Republicans support the conservative policies, and the GOP bill passed without difficulty, 216-211. Rep. Thomas Massie (R-Ky.) joined all Democrats in voting against the bill.

The bill, dubbed the Lower Health Care Premiums for All Americans Act, includes policies that are widely popular among Republicans — including funds to pay for “cost-sharing reductions,” reforms to the pharmacy benefit manager industry, and an expansion of association health plans.

But the GOP’s unity on the leadership bill belied the underlying tensions within the House GOP conference, where Speaker Mike Johnson (R-La.) and his centrist wing have jousted for weeks over the fate of the enhanced ObamaCare subsidies — an issue that could play an outsized role in the battle for control of the House in next year’s midterms.

Those tensions boiled over this week when negotiations between GOP leaders and moderates over allowing an amendment vote on a plan to extend the subsidies with some reforms broke down.

In response, four moderate GOP rebels in swing districts hopped the aisle to sign a discharge petition led by Democratic leadership to force a vote to extend the enhanced subsidies for three years. Afterward, the frustrated Republicans pinned the blame on Johnson and GOP leaders, saying they had given the rebels no choice.

“As I’ve stated many times before, the only policy that is worse than a clean three-year extension without any reforms, is a policy of complete expiration without any bridge. Unfortunately, it is House leadership themselves that have forced this outcome,” Rep. Brian Fitzpatrick (R-Pa.), one of the rebels, said in a statement.

Rep. Mike Lawler (R-N.Y.), who also signed the Democrats’ petition, echoed that message.

“I still believe a straight three-year extension is not the right policy, but I fundamentally believe doing nothing is even worse,” he said. “And to me, leadership left us with no option.”

The existence of the GOP health care package is in large part due to Democrats in Congress bringing the subsidies to the forefront of debate, and demanding negotiations on the matter as a condition of ending the government shutdown. While Democrats failed in getting a bipartisan compromise, they succeeded in highlighting the issue of rising premiums for ObamaCare enrollees, adding to voter concern about affordability.

Republicans have used their health care bill as a way to combat that Democratic messaging, arguing that they are looking for ways to lower premiums across the board and not just for the 22 million Americans who receive enhanced subsidies — who Republicans say amount to just a small percentage of the population.

“Democrats are worried about 6 percent of our country. Republicans are worried about 100 percent of our country, and premiums are going up, and not a single Republican has ever voted for ObamaCare,” said Rep. August Pfluger (R-Texas), chair of the conservative Republican Study Committee.

But Fitzpatrick told reporters on Wednesday that, while the percentage of beneficiaries might be relatively small, the erosion of federal help is significant — especially for those directly affected.

“We keep getting this number thrown at us, that it’s only 7 percent of the population. But for that 7 percent, this is everything,” he said. “I know some of those 7 percent, so I don’t even like that narrative.”

Other moderate Republicans accused their own leadership of pursuing a half-baked health care strategy that was launched too late to ever be effective.

“There’s unfortunately been a lack of leadership on this issue,” said Rep. Kevin Kiley (R-Calif.). “The fact that … the idea just seemed to dawn on leadership to come up with it, like, in December, [and it] doesn’t actually address the crisis that is coming on Dec. 31 — that is frustrating.”

The breakdown of the talks over the ObamaCare subsidies means Congress is out of time to prevent out-of-pocket health costs from skyrocketing for millions of people at the start of next year. Lawmakers in both chambers are scheduled to leave Washington for the long holiday break at the end of this week. And while the Democrats’ discharge petition will force a vote on the three-year extension, House rules prescribe a waiting period before the bill can be called to the floor — a timeline that is all but certain to push the vote into January.

Republican leaders say the party will continue to work on health care issues in the new year. Johnson on CNBC on Wednesday said he hopes to advance another reconciliation bill in the first quarter of the new year with more “revisions” to the health care system.