Senators sparred Wednesday over what to do about expiring Affordable Care Act subsidies, exposing sharp partisan divides as Republicans sought long-term changes and Democrats urged a straightforward extension with a year-end deadline approaching.
The Senate Health, Education, Labor, and Pensions Committee signaled interest in compromise during a hearing on affordability, but members failed to reach consensus on how to address the expiring enhanced subsidies that could drive up health insurance premiums.
Republicans signaled they want an overhaul that addresses rising deductibles and persistent out-of-pocket costs, while Democrats pressed for an immediate renewal of the enhanced subsidies first approved during the pandemic.
The divide left the Senate without a clear path forward at a moment when congressional leaders are warning that time is running short.
Sen. Josh Hawley, R-Mo., said the issue demands urgent action, citing projected premium increases affecting millions of people enrolled in Affordable Care Act exchanges.
He warned that letting the enhanced subsidies lapse would hit families already struggling with increased medical costs.
"If we do not do something on this issue, if Congress does not take action, this will be a crisis for 24 million Americans and counting," Hawley said.
He unveiled a plan to let Americans deduct up to $25,000 in medical expenses, a move that addresses the GOP's push for structural changes instead of keeping the current subsidy system.
Committee Chair Bill Cassidy, R-La., opened the hearing by calling for a bipartisan solution within the next three weeks.
He has also drafted his own major overhaul and has begun working with Rep. Josh Gottheimer, D-N.J., on a bicameral framework.
"Let us try to find a way we can all live with," Cassidy said.
But the early bipartisan tone quickly met resistance.
When Sen. Bernie Sanders, I-Vt., pressed for a straight extension of enhanced subsidies, Cassidy argued that the Affordable Care Act exchanges impose unaffordable deductibles, leaving many families effectively uninsured.
"The reason people are uninsured is because they have $6,000 deductibles," Cassidy said.
"As a doctor, I know that was a barrier to care. That is the status quo.
"We can change that status quo for next year. I do not want people to be underinsured," he said.
Cassidy proposed using the enhanced subsidy funding to create a government-backed health savings account that consumers could use to cover the higher out-of-pocket costs associated with bronze-tier plans, which have lower monthly premiums but significantly higher deductibles.
Sanders rejected that idea, saying the approach "is not going to guarantee health insurance to all people."
Senate Majority Leader John Thune, R-S.D., has told Democrats he will allow a vote next week on a subsidy extension.
That vote is expected to fail because of Republican opposition, leaving the possibility of a bipartisan package or a GOP alternative uncertain as the subsidy sunsets.
Jim Thomas ✉
Jim Thomas is a writer based in Indiana. He holds a bachelor's degree in Political Science, a law degree from U.I.C. Law School, and has practiced law for more than 20 years.
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