A unified plan on health care remains elusive for Senate Republicans as separate factions push in different directions, all while the party faces pressure to respond before next year’s midterms. The central question is whether to extend enhanced subsidies under Obamacare or let them lapse, a move that would shape voter perceptions and electoral dynamics.
Some GOP lawmakers aim to preserve the enhanced subsidies to avoid voter backlash and a politically painful midterm environment. Others argue for allowing the subsidies to expire and replacing them with direct cash payments to Americans, believing they can place the blame on Democrats for rising costs.
This week, Sen. Bernie Moreno (Ohio) and Sen. Susan Collins (Maine) unveiled the Consumer Affordability and Responsibility Enhancement (CARE) Act. Their proposal would extend the current enhanced Obamacare subsidies for two years and accompany it with conservative-leaning reforms. A key feature shared by several competing ideas is a subsidy income cap—set at households making $200,000 or more—and a requirement that plans no longer carry zero premiums by mandating at least a $25 monthly payment.
Moreno and Collins described the plan as a way to curb “fraud and abuse” associated with zero-premium options. Similar concepts have appeared in bipartisan proposals circulating in the House, and there was also a leaked White House proposal that was pulled after Republican objections.
The Senate is expected to vote later this week on a Democratic plan to extend the expiring subsidies for three more years. That proposal is unlikely to secure the 60 votes needed to pass. Republicans, however, have not settled on a unified counterproposal or whether to offer one at all.
Separately, Sens. Bill Cassidy (R-La.) and Mike Crapo (R-Idaho) are circulating a plan that does not renew the subsidies. Instead, it would channel the funds into Health Savings Accounts tied to bronze or catastrophic ACA exchange plans. Under their outline, certain Obamacare enrollees with incomes below 700 percent of the federal poverty level would receive HSAs—$1,000 for ages 18–49 and $1,500 for ages 50–64—with explicit language stating these HSAs would not be used to purchase abortion coverage, a point of contention for some conservatives.
If Congress fails to act by year’s end, the enhanced Obamacare subsidies would lapse, restoring the program to its original 2010 levels.
