Why Senate Republicans aren't uniting behind a health care plan

Senate Republicans have no shortage of health care plans. The challenge is getting all 53 of them to rally behind one.

Three days before a high-profile vote on a Democratic proposal to extend expiring Obamacare subsidies, GOP senators are nowhere near coalescing behind any single alternative that could be put up alongside it. Instead, Republican leaders appear happy allowing their members to freelance, even as Democrats and some in their own ranks fume at the lack of clear direction.

For Republicans, the risk of proceeding Thursday with a side-by-side vote is clear. While Democrats say they will have their entire 47-member caucus behind the three-year extension, any GOP plan right now is likely to fall well short of complete unity — and highlight the divisions in their party.

Senate Majority Leader John Thune called the upcoming vote on Democrats’ plan “a political messaging exercise,” one he agreed to last month as part of a deal to end the 47-day government shutdown. He didn’t commit to putting up a GOP counteroffer for a vote.

“I don’t think they’re serious about wanting to do a deal yet, so I think that may be what this week is about,” Thune told reporters Monday. “But we’ll see from there if there is a genuine interest in trying to do something.”

GOP senators are expected to further discuss their options at a closed-door lunch Tuesday and make a final decision about their posture. But, according to three Republican aides granted anonymity to comment on internal conference dynamics, leaders are not currently expected to offer an alternative for a vote Thursday.

One of the aides said Republicans will be prepared to make the case they have plenty of ideas and are ready to talk with Democrats once they move off a proposal that won’t get the 60 votes needed to advance.

But some Republicans want their leaders to put some concrete alternatives forward as more than 20 million Americans face the loss of enhanced Obamacare tax credits that were implemented as a Covid relief measure under President Joe Biden in 2021 and later extended through 2025. Without them, many families could see premiums rise by $1,000 a year or more.

“What signal would that send if Republicans say, ‘Yeah, we’re going to say no to the Democrats’ plan, but we’re not going to offer anything?’” Sen. Josh Hawley (R-Mo.) said. “The message that will send is, good luck to the American people, and we don’t really care.”

Sen. John Kennedy (R-La.) said in an interview that simply standing aside while Democrats vote to extend the subsidies would be “a big mistake.”

“A lot of my colleagues, I think, will be very upset if we don't put something up,” he said.

But there are multiple competing proposals that are favored by subsets of the Senate GOP. Some of them include shorter extensions of the expiring subsidies. Others seek to replace them with new frameworks, generally involving giving Americans cash in the form of health savings accounts to help underwrite premiums and other costs.

Sen. Rick Scott (R-Fla.) is among those pushing for a clean break from the Affordable Care Act subsidy framework that reflects “what we believe in” as free-market-oriented Republicans. “I always think it's good to have an alternative,” he said in an interview.

But Thune praised another proposal being circulated by Sens. Mike Crapo of Idaho and Bill Cassidy of Louisiana, who chair the health-oriented Finance and HELP committees, respectively.

Their proposal, released Monday, would expand the use of health savings accounts and direct funding toward them without extending the enhanced Obamacare subsidies.

Cassidy said Monday that it is a “leadership decision” if his proposal gets a vote Thursday. Thune took steps Monday night to make the bill available for a vote later this week, as Republicans try to keep options on the table ahead of Tuesday’s lunch.

But Thune also acknowledged some of his members have other ideas centered on extending the enhanced subsidies with a new income cap and other eligibility restrictions. Republican Sens. Bernie Moreno of Ohio and Susan Collins of Maine, for instance, propose to extend the expiring subsidies for two years with income cap restrictions and minimum premium payments.

That proposal won some Democratic interest Monday from Sen. Dick Durbin (D-Ill.), the No. 2 party leader, who called it “encouraging” and “in the ballpark” of a workable solution — though he cautioned he hadn’t seen the details.

“It's not crazy,” Durbin said. “Let’s have a conversation.”

The Senate GOP is straining to formulate a path forward as House Republicans race to come up with their own plan in hopes of putting some health care legislation up for a vote next week before lawmakers break for the holidays — and the enhanced subsidies expire, returning them to the original levels as passed in the 2010 Affordable Care Act.

House GOP leaders still need to make key decisions, including if they try to assemble one bill or put up a suite of bills for members to pick and choose from. But they, too, are under pressure from a slice of members to embrace an extension of the subsidies — even as most in the party are happy to see them expire.

President Donald Trump hasn't put forward his own framework, which could have helped rally the disparate factions of his party on Capitol Hill. And Senate Minority Leader Chuck Schumer hammered Republicans Monday, saying that they “have no plan.”

“The question Republicans face this week is very simple: Will they support our bill and lower people’s premiums or will they block our bill and send premiums through the roof?” Schumer said from the Senate floor Monday.

While the Democratic proposal is expected to fall well short of the necessary 60 votes, a handful of Republicans haven’t said yet how they will vote. Hawley, for instance, said Monday “everything is on the table.”

“What I’m not going to do is do nothing,” he said.

It's likely Thursday’s vote won't be the last word on health care this Congress. Thune left the door open to further bipartisan negotiations, and there’s some hope on both sides of the aisle that a failed vote — or votes — could in fact lend new momentum to the talks. Lawmakers are increasingly eyeing Jan. 30, the next government funding deadline, as the real cutoff to land a health care deal.

But getting to that point will require Democrats to compromise and Republicans to get together behind a plan of some kind. Asked Monday if his ranks were united or divided on health care, Thune acknowledged reality for a party that has struggled on the issue for decades.

“I think we have people in different camps, as you would expect,” he said.

Calen Razor and Benjamin Guggenheim contributed to this report.

CORRECTION: An earlier version of this article misstated the average premium increase for households losing enhanced subsidies. It is about $1,000 a year.