A divided GOP forges ahead on health care message — without plan to address spiking premiums

By Sarah Ferris, CNN

(CNN) — Congressional Republicans are taking a major political gamble this week, laying out a GOP health care agenda that ignores the soon-to-expire enhanced subsidies that help tens of millions of Americans afford Obamacare — despite pleas from some in their own party.

Top Republicans didn’t come to the decision easily. As recently as last week, it wasn’t clear whether GOP leaders in either chamber would offer their own health care plans alongside a high-profile Democratic push to extend those Covid-era Obamacare subsidies.

There are plenty of frustrated rank-and-file members still trying to convince Republican leaders to change course and offer a short-term fix for the subsidies. Multiple battleground Republicans are plotting how they can intervene, including lobbying President Donald Trump directly or potentially going around their own leadership to force a vote on extending the subsidies, multiple sources told CNN. While they say Obamacare is rife with problems, they insist Republicans can’t simply allow huge premium hikes for millions of people – especially in an election year.

Rep. Nicole Malliotakis, a centrist from New York, said her next step is to “appeal to the White House.”

“I know, based on his previous comments, that the president is very interested in doing something to address this issue that was a problem Democrats created and was dumped on our laps,” she said. If not, there’s always what she called the “nuclear option” of forcing a vote with help from Democrats by way of a discharge petition.

If the enhanced subsidies lapse, enrollees will see their premium payments more than double — or about $1,000 — on average, according to KFF, a nonpartisan health policy research group. And roughly 2 million more people are expected to be uninsured next year if they lapse, according to CBO.

But for now, Senate Majority Leader John Thune and his House counterpart, Speaker Mike Johnson, have opted for health care measures that seek to address rising costs without tackling the contentious subsidies. And Trump is staying out of the fray.

The focus on health care comes as the party is eager to show voters that they’re tackling rising costs for everyday Americans, with both leaders under intense pressure to show real progress soon. But Republicans in Congress are limited in what they can do with their slim majorities, and GOP chairs in both chambers are opting to focus on years-old ideas like expanding health savings accounts with broad support in the party.

In the Senate, Republicans put to a vote Thursday a bill to expand health savings accounts to help people in certain Obamacare plans afford care. It failed as expected.

The plan, from top GOP chairmen Bill Cassidy and Mike Crapo, would funnel money for two years into health savings accounts for certain lower-income and middle class Americans. The legislation would also resume federal funding of Obamacare’s cost-sharing subsidies, which will help reduce premiums of certain plans.

The chamber also voted on a similarly partisan bill from Democrats, which would fund three more years of Covid-era subsidies, which have allowed low-income Americans to obtain coverage with $0 or near $0 monthly premiums while allowing many middle-class consumers to qualify for aid for the first time. It did not draw the support needed to advance.

The dueling proposals, though destined to fail, offered a preview of the 2026 political messaging from both parties.

Sen. Susan Collins of Maine — one of the Senate GOP’s most centrist members — supported the Democratic plan, though she has expressed some skepticism in recent days of the decision not to include changes to the existing system.

“There’s still some negotiations going on,” she said ahead of the vote. “As I’ve made very clear, I want to see an extension of the enhanced premium tax credits, but with reforms such as a cap for high income people so that they’re not receiving taxpayer subsidized credits, and I believe there should be a minimum amount, perhaps as low as $5 a month, to help reduce fraud in the program. So I’m still talking with people on both sides of the aisle to see what the votes are actually.”

Collins, according to an aide, felt both bills had merit and had components that could be in a final compromise bill.

With support for the proposals falling largely along party lines, it’s a reminder of why Congress is days away from the expiring subsidies with no real solution in sight: No one is in the mood for dealmaking – yet.

For weeks, moderate Republicans and Democrats have insisted that Congress’ only way to avert the premium hikes on December 31 would be jumping together. Republicans would need to take their first-ever vote to stand up Obamacare by extending the subsidies, while Democrats would need to acknowledge problems in the system, like skyrocketing costs and some fraud.

Some centrists are hopeful that real bipartisan work can now begin after the Senate’s votes failed as expected on Thursday. But it’s still not clear whether GOP leadership — particularly Johnson — have an appetite to have that fight among their ranks.

“There’s a lot of people who are very concerned about Obamacare and the fact that the subsidies were created by Democrats for Covid-era limited use, and they want to be extended. We just can’t get Republican votes on that for lots of reasons, not enough of them,” Johnson said when asked about extending the subsidies.

Johnson was also critical of efforts by moderates in his caucus, including Rep. Brian Fitzpatrick, who formally filed a discharge petition for a bill to extend the ACA subsidies.

“I am not a fan of discharges. It is typically used as a tool against the majority. I understand the concerns that they have, and I’m very sympathetic to that,” he told reporters Wednesday.

Fitzpatrick, meanwhile, declared that “the discharge petition is now live and it has enough Republican signatures to now allow our Democrat colleagues to finish the job, if they so choose.”

Johnson and his conference are planning their own slate of health care bills for next week, similarly focusing on health savings accounts and cost-sharing reductions.

Some hardliners in the conference – faced with the prospect of a discharge petition – privately expressed openness to a bill to extend subsidies in a closed-door meeting on Wednesday, but there appears to be no consensus on what kind of bill could pass the House in time. (Even Ohio Rep. Jim Jordan suggested House Republicans should act on the subsidies, warning that a discharge petition with Democratic sign off would be a worse alternative, according to two people briefed on his remarks.)

“It’s like nailing jello to a wall with a lot of these members,” said Rep. Ralph Norman, who said he was open to the subsidies for a short period.

“But extend them for how long? That’s always the contentious part,” Norman said.

Thune, meanwhile, held out a long-shot possibility that a bipartisan compromise could be reached to extend the enhanced Affordable Care Act subsidies before they expire. Such an effort would require a dramatic shift in positions from members of both parties and would have to come quickly as both chambers are only scheduled to be in session through next week.

Asked if the subsidies were set to officially expire on December 31, Thune was hesitant to say so definitively.

“I don’t know. I wouldn’t say that,” Thune said. “When we get through this exercise this week, the question is, are there enough Democrats who actually want to solve the problem to work the Republicans? A lot of us who want to fix the problem. Or are they going to succumb to their leadership and probably their far left base and just make this a political issue?”

Thune pointed to conversations between bipartisan rank-and-file members trying to find a path forward that might have success after Thursday’s Senate votes.

“If there’s an interest in solving it, I don’t rule it out. I mean, obviously, we don’t have a lot of time,” he said.

House and Senate leaders have one tool at their disposal to circumvent Democrats: a partisan gambit known as reconciliation. But Thune said he would prefer a bipartisan compromise that could get 60 votes to overcome a filibuster because the resulting legislation is “more durable.”

Still, Thune said he “wouldn’t rule anything out.”

House GOP leaders, however, are privately bearish on another reconciliation bill this Congress after their Herculean effort to pass Trump’s tax and spending measure this summer. (Trump himself seemed uninterested in another big domestic package on Wednesday, saying, “We don’t need it.”)

Exactly which plans will get a vote in the House is not yet determined. A closed-door meeting of House Republicans on Wednesday ended without a sense of unity on a path forward. House Majority Leader Steve Scalise told reporters the leadership team would spend the coming days finding consensus on a handful of bills to come to the floor next week, likely focusing on health savings accounts and cost-sharing reductions.

But the divergence in opinion across the conference on the subsidies issue was yet another reminder that Trump and his GOP have yet to unify behind a clear health care agenda eight years after the party’s failed attempt to replace Obamacare.

And inside that meeting, multiple endangered lawmakers privately pressed Republican leaders to address the expiring subsidies — but faced sharp pushback from the right flank of their party. One of those members was vulnerable GOP Rep. Kevin Kiley of California, who called on Johnson to put a bill on the floor to extend the tax credits.

If that didn’t happen, he warned, Republicans would face the consequences next November.

“There’s perhaps no single policy measure that would have a more dramatic impact on affordability in the year ahead than doing something about the expiration of the subsidies. So if we go home without addressing that, that is a huge loss,” Kiley said.

This story has been updated with additional developments.

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CNN’s Tami Luhby, Ted Barrett, Aileen Graef, Annie Grayer and Ellis Kim contributed to this report.