An inpatient care room in a rural hospital in Holton, Kansas. Photo by Arin Yoon/Reuters
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WHAT CONGRESS IS (NOT) DOING ABOUT HEALTH CARE
By Lisa Desjardins, @LisaDNews
Correspondent
We have a lot to talk about because, at the moment, Congress is stalled on a critical issue.
In about 22 days, a large portion of government health care subsidies expire, affecting the cost and availability of insurance for no less than millions of people.
And yet, Congress is set to leave Washington in two weeks. While we suddenly have a number of plans to try to fix this problem, there is also Republican paralysis over which one they want.
Let’s go over some basics to start.
What is expiring? A set of federal subsidies that makes health insurance premiums cheaper for millions of Americans on the Affordable Care Act, or Obamacare, exchanges. These are called “enhanced premium tax credits,” with a rhyme-friendly acronym: PTCs. They are “enhanced” because they were added on top of the initial subsidies during the pandemic.
How would the loss of subsidies affect plans? KFF, a nonpartisan health policy research group, calculated that on average premiums for people enrolled in enhanced subsidized coverage would more than double in 2026.
Who would lose these subsidies? Americans who earn an annual income of more than 400% of the federal poverty limit and who get their health insurance on the exchange stand to lose subsidies if Congress doesn’t act. The amount of subsidies depends on income levels and costs in each state. Subsidies would stay in place for those earning under 400 percent of the poverty level.
What are the basic ideas about how to deal with this? Lawmakers are currently floating many plans (see below), but there are a few key concepts among the competing proposals.
Simply extend existing subsidies.
Extend the subsidies and reform them with income caps and new co-pays.
Replace the subsidies, which go to insurance companies, with direct payments to individuals, to be used to shop for health care either within or outside of the Affordable Care Act. These usually are called HSAs or “health savings accounts.”
What are elected leaders proposing to do?
Here is a quick look at the major options and their supporters right now.
No plan yet: President Donald Trump and House Speaker Mike Johnson
Move to HSAs: Senate Republican Leader John Thune
Extend current subsidies: Democratic leaders Chuck Schumer and Hakeem Jeffries
What specific plans are on the table?
Quite a few. These are the prominent proposals at the moment.
First, the extenders.
Democratic leaders Chuck Schumer and Hakeem Jeffries proposed a three-year extension of the ACA subsidies. Photo by Evelyn Hockstein/Reuters
The Moreno-Collins plan. From Sens. Bernie Moreno, R-Ohio, and Susan Collins, R-Maine. This is not a full bill, but a framework.
Extend the enhanced subsidies? Yes. For two years and end them after that.
Income limit? Yes. It would add a $200,000 household income limit and require a minimum payment of $25 per month.
Income limit? Yes. This plan would phase out subsidies for those earning between 600% and 1,000% of the poverty level. This would extend open enrollment to March 19, 2026. It also would tee up votes on larger reforms, potentially including HSA accounts.
Extend enhanced subsidies? Yes, but changes them substantially.
Income limit? Yes. 700 percent of the poverty level.
HSA replacement? Yes. Subsidies would be placed in HSA accounts, which would vary based on age: $1,000 for people aged 18 to 49 and $1,500 for those 50 to 65.
The Scott plan. From Sen. Rick Scott, R-Fla. This also is a formal bill, titled the “More Affordable Care Act.”
Extend enhanced subsidies? No.
HSA replacement? Yes. Scott would keep remaining subsidies, which would revert to the original ACA limit of 400 percent of the poverty level. Those individuals would receive the subsidies in a “Trump Health Freedom Account,” a HSA-style account, which they could use to pay for premiums or other medical costs.
What happens now?
The Senate will hold two votes Thursday: one on the Democrats’ three-year extension and one on a plan from Senate Republicans (the Crapo-Cassidy plan).
Neither is expected to pass.
And it is not clear what, if anything, the House and White House might propose.
It will be worth watching this week to see if any Democrats or Republicans vote with the other side in the Senate. But after that, the next steps are not clear.
The bipartisan groups in the House may attempt a discharge petition, which is one way to get around a leadership block. But it is not clear they can attract the 218 signatures they need for any one idea.
One Big Question: What’s at stake for President Donald Trump and Republicans in that redistricting fight? NPR’s Tamara Keith and Amy Walter of the Cook Political Report with Amy Walter discuss.
The Supreme Court heard arguments Monday in a case that considers whether President Donald Trump acted legally when he fired a Democratic member of the bipartisan Federal Trade Commission.
Depending on how the justices’ rule, their decision could overturn 90 years of precedent that limits presidents’ power to remove independent agency leaders.
Decades before Trump, another president sought to fire a FTC commissioner.
Our question: Which president attempted to fire an FTC commissioner over ideological disagreements, which touched off a landmark legal battle over presidential removal power?
Send your answers to [email protected] or tweet using #PoliticsTrivia. The first correct answers will earn a shout-out next week.
Last week, we asked: Which former Speaker of the House was first elected in a special election?
The answer: Nancy Pelosi. She was first elected to the U.S. House in a special election in 1987, months after the death of her predecessor, Sala Burton, who died of colon cancer.
Congratulations to our winners: Brenda Radford and John Finch!
Thank you all for reading and watching. We’ll drop into your inbox next week.
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