Dem
47
GOP
53
Health care premiums for the ACA (and for non-ACA plans) are about to skyrocket and Republicans are going to get blamed. But they don't know what to do about it. They are all over the map on possible ways to get the monkey off their back.
Retiring Sen. Thom Tillis (R-NC) said: "I want all the Obamacare subsidies to be gone," although he was willing to phase them out over time. The consequence of ending the subsidies would be that millions of people, including large numbers of Trump voters, would lose their health insurance. Also, many rural hospitals would go under. This is a valid policy choice in the sense it could be implemented fairly easily, but it probably would not be terribly popular.
Some other Senate Republicans just want to send money to Americans and let them figure it out. Others like Health Savings Accounts. In short, GOP-ers are all over the map and insurance-buying season is now in full swing and people are seeing huge premium increases. If nothing is done, many young healthy people will drop their insurance, leaving only older, sicker people in the insurance pool. Insurance companies will respond by raising premiums, leading to a death spiral.
Sen. Rick Scott (R-FL) introduced a bill that kills the subsidies but creates "Trump Freedom Accounts." Details are sketchy, which makes sense because Scott himself is sketchy, but probably people could put pre-tax money in them and use them to pay health insurance premiums. It would also allow insurers to sell policies across state lines, thus evading state insurance regulators, long a GOP goal. Sen. Bill Cassidy (R-LA) said: "Right now, it's trench warfare."
For Democrats, the situation is simple. They want to keep the current ACA subsidies in place. The one concession Democrats got from Senate Majority Leader John Thune (R-SD) when they agreed to end the shutdown is a promise to hold a vote in December on extending the subsidies. Every Democrat will vote for it, but they need four Republican votes as well. And even then, the House has to agree.
Some House members are working on various plans, but there isn't a lot of time left. Enrollment is ongoing and one study, from KFF, showed an increase of out-of-pocket premiums by 114%. People are going to notice that, especially since grocery prices are also up. One potential outcome is a classic: Kick the can down the road. The subsidies could be extended for a year as-is, but then the problem would just come up next year, as nothing would have been solved. However, if the can is kicked, that might avoid a bloodbath for the Republicans next November. From that perspective, can-kicking is a good plan for them. (V)