The Senate voted down competing health care proposals on Thursday, likely guaranteeing that the enhanced Affordable Care Act tax credits will expire at the end of the year.
Why it matters: The failed votes on Democratic and Republican plans highlight the deadlock in Congress over how to respond to steep increases in out-of-pocket premium costs for millions of ACA enrollees.
- Democrats got the vote on their proposal in exchange for ending this fall's government shutdown. Its defeat assures the issue, and broader concerns about health care affordability, will spill over into midterm elections.
Driving the news: The Senate Democratic proposal, which would have extended the enhanced subsidies for three years, failed 51-48. It needed the support of 13 Republicans to get to the 60 votes for passage.
- Four Republicans — Susan Collins of Maine, Josh Hawley of Missouri and Lisa Murkowski and Dan Sullivan of Alaska — voted for the Democratic plan.
- The GOP proposal, which would not have extended the subsidies but instead would have provided payments of $1,000 to $1,500 into health savings accounts for certain ACA enrollees, also failed on a vote of 51-48.
- GOP Sen. Rand Paul (Ky.) voted against the GOP plan.
The big picture: Senate Majority Leader John Thune has said he's open to continued bipartisan talks on a health care package, but there is deep skepticism in both parties that a deal can come together.
- Democrats are pushing the three-year extension without modifications, saying many GOP-backed changes to the subsidies are not feasible with little time remaining before the start of a new coverage year.
- Many Republicans remain opposed to any kind of subsidy extension, arguing it is wasteful spending that benefits insurance companies. Other GOP lawmakers are all over the map on what kind of changes they would accept.
Between the lines: Republicans have accused Democrats of playing politics instead of seeking a true compromise.
- But Democrats feel the political winds are in their favor: a KFF poll last month found 74% of the public favors a subsidy extension.
The intrigue: In the House, two bipartisan groups of lawmakers have filed discharge petitions seeking to force a vote on compromise subsidy extensions, over the objections of GOP leaders.
- It remains unclear whether enough Democrats will sign onto the plans to get to a majority in the House amid questions about whether the plans have any chance of becoming law.
- Even if a subsidy plan passed the House, Senate GOP leaders could block it.
