No ‘clear path forward’ in Senate on spiraling health care costs

Republicans and Democrats in the Senate agree that health care costs are rising too quickly and expect to vote next week on legislation that could help Americans.

The only catch is that party leaders hadn't decided as of Tuesday what to include in the bills.

Senators also seemed to accept that neither proposal will garner the bipartisan support needed to advance, leaving the tens of millions of Americans who purchase their health insurance from the Affordable Care Act marketplace with complicated decisions to make before open enrollment ends Dec. 15.

ACA marketplace plans are expected to increase by 26% on average next year, though a failure by Congress to extend enhanced tax credits would lead monthly payments for subsidized enrollees to increase by 114% on average, according to analysis from the nonpartisan health organization KFF.

"I don't think at this point we have a clear path forward," Senate Majority Leader John Thune said. "I don't think the Democrats have a clear path forward."

Vote on Democratic LEGISLATION expected

Thune guaranteed a small group of Democratic senators a floor vote on a health care proposal of their choosing in exchange for their votes on the spending package that ended the government shutdown.

Democrats are widely expected to put forward a bill to extend enhanced tax credits for people who buy their health insurance from the Affordable Care Act Marketplace. Those subsidies are set to expire at the end of the year without congressional action.

But it isn't clear if the Democratic bill would extend the credits for one year or a longer period.

GOP leaders are trying to rally support around a health care proposal of their own, while acknowledging it won't get the 60 votes needed to advance under the Senate's legislative filibuster rules.

Thune said Republican senators had a "robust discussion" about health care issues during their closed-door lunch, where Finance Committee Chairman Mike Crapo of Idaho and Health, Education, Labor and Pensions Committee Chairman Bill Cassidy of Louisiana presented some ideas. But no final agreements were reached.

Thune, R-S.D., said conversations will continue ahead of the vote next week and likely afterward.

Senate Minority Leader Chuck Schumer of New York said Democrats "have a plan" but declined to say exactly what it entails.

"Stay tuned," Schumer said. "We had a great discussion and I will tell you this: We will be focused like a laser on lowering people's costs."

Looking for a solution

West Virginia Sen. Shelley Moore Capito said Republican talks on health care have been "vigorous" but that they hadn't yet "decided on the clear path."

Capito said her "expectation" is that GOP senators will put a bill on the floor next week to bring down the costs of health insurance premiums and health care as quickly as possible, though that hadn't been finalized.

"I like the idea of people having control of the money as opposed to insurance companies, where they take a 20% profit," Capito said, echoing comments by President Donald Trump. "I think that has merit."

Capito said senators didn't discuss during their lunch whether to extend open enrollment past Dec. 15 or possibly reopen it next year, should Congress pass a health care bill that addresses the ACA marketplace tax credits in some way.

New Hampshire Democratic Sen. Jeanne Shaheen said there is no indication there will be bipartisan agreement to extend the enhanced ACA subsidies or any other health care proposal by next week's vote, though bipartisan conversations continue.

As for Democrats' plan, Shaheen said it wasn't "clear" what legislation party leaders will put on the floor for a vote or when they'd make that announcement.

'Mindful of the timeline'

North Dakota Republican Sen. John Hoeven said there is "strong support" among GOP lawmakers for making changes to how the enhanced ACA tax credits work before extending them for any length of time.

But he said those negotiations will take more time.

"In my opinion, if we have (the vote) next week, we probably won't be at a point where we can get a big bipartisan agreement," Hoeven said. "It's more likely they'll put something up that fails. We put something up that fails. And we keep working towards, hopefully, something that can work and that is bipartisan."

There is a "good chance," he said, that will happen in December or January, a timeline that would likely put a solution after open enrollment closes.

Hoeven declined to say if a deal would extend open enrollment or include a second window for Americans to select insurance, but said Republicans are aware of the deadlines.

"We're very mindful of the timeline," Hoeven said. "So all the things we're talking about recognize that it needs to be able to take effect next year or this year."