WASHINGTON—The House of Representatives on Dec. 17 passed a health care reform bill amid an intra-party debate on whether to extend the expiring enhanced premium tax credits offered in the Affordable Care Act exchanges.
The Lower Health Care Premiums for All Americans Act aims to lower health insurance premiums in both the Affordable Care Act exchanges and the general market. The Affordable Care Act is former President Barack Obama’s health care law, known as Obamacare.
The bill passed in a 216–211 vote. One Republican, Rep. Thomas Massie (R-Ky.), joined all Democrats in voting against the bill.
Following the vote, Speaker Mike Johnson (R-La.) touted the bill’s passage as a more significant achievement than extending the temporary subsidies would have been.
“What we just passed off the floor will reduce everybody’s premiums by 11 percent,” Johnson said, comparing it with the 5.7 percent reduction a subsidy extension would yield. “We did a better and more important thing for 100 percent of Americans, not just 7 percent of Americans.”
Disagreement Over Enhanced Subsidies
Rep. Brian Fitzpatrick (R-Pa.) and three other Republicans had earlier joined a discharge petition circulated by Minority Leader Hakeem Jeffries (D-N.Y.) to force a vote on a three-year extension of the subsidies.
That move came after an amendment sponsored by Fitzpatrick and another advanced by Rep. Jen Kiggans (R-Va.) were rejected by the House Rules Committee.
The amendments mirrored bipartisan bills each had sponsored that would have extended the enhanced subsidies for two years and one year, respectively, with accompanying changes to reduce the cost and combat fraud.
Fitzpatrick, joined by Reps. Mike Lawler (R-N.Y.), Robert Bresnahan (R-Pa.), and Ryan Mackenzie (R-Pa.), provided the final signatures needed to reach 218, forcing a vote on the Democrats’ proposal.
Under House rules, seven legislative days must pass before a signer of the petition can call for a vote. The speaker then has two legislative days to schedule it.
Democrats have called on Johnson to waive the waiting period and schedule the vote immediately.
Johnson, when asked whether Republicans’ siding with the opposition was a signal that he had lost control of the House, said that that was not the case.
“These are not normal times,” Johnson said, noting that the party’s slim majority in the House allows members to exert leverage that they otherwise could not.
Bill Aims to Lower Premiums
The Lower Health Care Premiums for All Americans Act includes five provisions to reduce the cost of health insurance and broaden access to it.
Those include requiring greater transparency in prescription drug pricing, providing federal funding to reduce the copayments and deductibles paid by some Obamacare customers, and making it easier for businesses that self-insure their employees to buy stop-loss insurance.
The bill would also make it easier for small employers and the self-employed to leverage the buying power of a larger organization by joining association health plans. And the bill would make it more attractive for employers to contribute pretax funds for employees to purchase their own coverage.
Republicans said the changes are needed because Obamacare has failed to live up to its promise of lowering the cost of health insurance.
“Obamacare premiums are up 80 percent since the program’s inception, with patients paying on average $5,000 out of their own pocket to hit their deductible,“ Rep. Brett Guthrie (R-Ky.) said during debate on the bill. ”The average out-of-pocket spending maximum for one year is over $20,000.”
“Obamacare has proven to be unaffordable and unsustainable,” Guthrie said.
Guthrie said the Republican bill would lower premiums by 11 percent compared with the 5 percent reduction realized by extending the enhanced subsidies.
Democrats countered that the expiration of the enhanced subsidies would make health insurance unaffordable for many Americans.
“Health insurance premiums are going to skyrocket for more than 20 million Americans across the country,” Rep. Frank Pallone (D-N.J.) said in arguing against the bill.
“Republicans are bringing a bill to the floor that does absolutely nothing to lower prices,” he said.
He said that in his view, the bill promotes “junk insurance plans.”
Senate Options
A three-year extension of the enhanced subsidies also failed to advance, although four Republican senators joined Democrats in support.
Sen. Susan Collins (R-Maine), who voted for the three-year extension, told reporters on Dec. 17 that the discharge petition helps her cause.
Sen. Bill Cassidy (R-La.) told reporters on Dec. 17 that he is “not personally opposed to subsidies.”
“It’s just not the end-all deal, because if somebody does need a subsidy but they have a $6,000 deductible, they’re effectively not insured,” he said.
Sen. Lisa Murkowski (R-Alaska), who also voted for the three-year extension, was asked on Dec. 17 whether the measure might yet pass in the Senate if forwarded by the House.
“I hope so,” she said.
