House Republicans successfully passed a premium-slashing health care package on Wednesday, overcoming a late-breaking revolt from House GOP moderates.
The bill, called the Lower Health Care Premiums for All Americans Act, passed by a vote of 216 to 211.
Only one Republican, Rep. Thomas Massie, R-Ky., voted against the bill. The Kentucky Congressman has long been opposed to health care subsidies.
The vote is a major win for House Speaker Mike Johnson, who had to overcome an eleventh hour revolt from GOP moderates before passage.
Moderates Revolt
Moderate Republicans revolted against House GOP leadership by signing a discharge petition, led by House Minority Leader Hakeem Jeffries, D-N.Y., to extend the expiring Obamacare subsidies for three years.
Four Republicans, Reps. Brian Fitzpatrick, R-Pa., Mike Lawler, R-N.Y., Rob Bresnahan, R-Pa., and Ryan Mackenzie, R-Pa., joined the Jeffries petition to get the number of signatures over the 218 needed to force a future vote on the extension. But with winter break beginning on Friday, it’s unlikely there is a vote on the extension before the end of the year.
The revolt was in spite of the fact that Johnson had met and negotiated with the “five families” of the House Republican conference. These groups range from the fiscally conservative House Freedom Caucus to the bipartisan Problem Solvers caucus.
The moderate members who revolted, however, still voted for the package. Just before the vote, Fitzpatrick told Politico he would vote for the GOP health care plan despite his support of the discharge petition.
“I’m not going to vote against something out of spite,” Fitzpatrick said.
Earlier in the day, Johnson and House Majority Leader Steve Scalise, R-La., huddled with some of the revolting members on the House floor. The conversation appeared to be intense as the leaders circled up with pro-extension Republicans such as Lawler, Mackenzie, Rep. Nick LaLota, R-N.Y., Rep. Kevin Kiley, R-Calif., and Rep. David Valadao, R-Calif.
LaLota explained to reporters outside the House chamber that the discussion had involved an effort to revive “a deal that was made…yesterday, wherein the speaker preferred the merits of the Fitzpatrick bill but the pay-fors of the [Rep. Jen] Kiggans [of Virginia] bill.”
Fitzpatrick’s bill proposes a two-year, income-capped extension of the credits, and Kiggans has offered an amendment which includes pay-fors in the form of cracking down on fraud in Obamacare exchanges.
LaLota said he hopes that there will eventually be a vote on credit extension in the House.
“I think that it will require now my leadership to contemplate whether they’re going to see a vote on a three-year extension, which will probably get 230 votes or so in the House, and put more pressure on the Senate for that flawed structure,” he said, or come to a deal to vote on a reformed extension with pay-for provisions included.
While the discharge petition for a three-year extension will force a vote on the floor, this extension has already been rejected by the Senate, so bringing such a bill to the floor will likely mean more for midterm messaging for Democrats and swing district Republicans than for real health care policy.
What’s in It?
The bill considered on the floor Wednesday was not a revolution in health care policy. Rather, the Lower Health Care Premiums for All Americans Act is a package of focused tweaks to Obamacare.
It would theoretically deliver lower premium prices for Americans as the expiration of COVID-era subsidies set under President Joe Biden were set to cause premium hikes.
The original premium tax credits were originally put in place by Democrats as part of Obamacare.
Under Biden, the credits were boosted to higher levels without an income cap in the party-line American Rescue Plan Act, and then extended by the party-line Inflation Reduction Act.
Therefore, Democrats have twice voted—without any Republican cooperation—to give the boosted credits an expiration date.
In October, Democrats shut down the government over the subsidies, which Republicans say are prone to fraud and abuse. Nevertheless, Democrats have continued fighting for extending the credits, which essentially provide massive subsidies for big insurance companies.
The House GOP bill would let these enhanced credits expire at the date set by Democrats under Biden, but put in place other premium-cutting provisions.
As for the premium-lowering provisions, the GOP plan looks to achieve lower health care costs by funding cost-sharing reductions to end a practice called “silver loading.” Silver loading is a term for when insurers increased premiums on the Obamacare silver-level plan to make up for no longer being reimbursed for offering the legally mandated cheaper copays and deductibles.
Additionally, funding CSRs is likely to reduce the federal deficit, per the Congressional Budget Office, because the premium tax credit subsidies have become more expensive due to the premium hikes from silver loading.
The bill will now go to the Senate, where it could have difficulty mustering 60 votes.
