Same As It Ever Was
With the government shutdown over, the Republican-led Congress is slowly turning its full attention to the issue that was at the heart of the shutdown: rapidly rising healthcare costs.
Republicans split on healthcare solutions as Democrats push for ACA subsidy extension
During the shutdown, Republican Congressional leadership insisted they would turn to the issue of the health care cost crisis as soon as the government reopened. We are now a few short weeks away from the product of their newfound focus coming to the fore as Senate Republicans promised a vote on a bill of Democrats’ choosing to extend the Affordable Care Act subsidies in the second week of December. It’s expected that Republicans will have their own legislation – a “side-by-side” bill to consider – as well. However, with a short timeline to address healthcare issues, Republicans remain divided, with some moderates backing a temporary extension and others looking for alternative solutions.
Some moderate Republicans have expressed an openness to a temporary extension. On November 3rd, Reps. Jeff Hurd (R-CO), Don Bacon (R-NE), Tom Suozzi (D-NY), and Josh Gottheimer (D-NJ) released a bipartisan statement of principles advocating for a 2-year extension of the tax credits, alongside an income cap and fraud-prevention provisions. On November 10th, Reps. Sam Liccardo (D-CA) and Kevin Kiley (CA-03) also introduced a bipartisan bill featuring similar provisions, including the 2-year extension. Earlier, Rep. Jen Kiggans and a slew of other moderates endorsed a simple 1-year extension. These proposals, though, have received little support from conservative Republicans in the House or Senate, who favor a complete repeal of the Affordable Care Act and a new, yet-to-be explained alternative health insurance system, building off of Health Savings Accounts (HSAs). However, as recent reports from both GAO and Senate Finance Committee Democrats show, HSAs don’t replace health insurance and are largely tax-advantaged accounts that primarily benefit the wealthy. Health policy experts say that renewing the ACA tax credits is the only, and best, approach that can address skyrocketing premiums before the end of the year.
Senate HELP Committee Chair Bill Cassidy (R-LA) released a proposal Monday to directly fund HSAs instead of extending the ACA credits. Though President Trump has not explicitly addressed the plans, Cassidy’s proposal is in line with the White House’s preferred approach, and Trump posted Tuesday that Congress should not “waste [its] time and energy” on anything other than “sending the money directly back to the people.” White House Deputy Chief of Staff James Blair said Tuesday that the administration is planning to release a health bill and may pursue partisan reforms through the reconciliation process if needed.
Appropriations leaders meet without agreement on path forward
On Thursday, the top four congressional appropriators — Sens. Susan Collins (R-ME) and Patty Murray (D-WA), and Reps. Tom Cole (R-OK) and Rosa DeLauro (D-CT) — met for the first time since the shutdown. While the meeting signaled a willingness to embrace bipartisan appropriations, the meeting showed few signs of progress, with the appropriators yet to agree on overall spending levels for FY26.
Collins is advocating for a package of up to five bills – including Defense, Labor-HHS, Commerce-Justice-Science, and Transportation-HUD, and possibly Interior – as the next spending package up for discussion, while Cole has argued for a smaller set of funding bills that can be advanced on a shorter timeline. Cole has also said that lawmakers should pursue a full-year CR for any bills that are not agreed upon by the end of January, though that idea has little support among Democrats.
The Senate Appropriations Committee still has four bills to markup — Energy-Water, Financial Services, Homeland Security, and State-Foreign Operations — and Collins said there would “most likely” be markups of those bills at some point.
Trump moves to dismantle the Education Department
On Tuesday, the Trump administration announced its plans to slash the work of the Education Department and move the majority of its responsibilities to other agencies, including the Departments of Labor, State, Interior, and HHS. Trump has repeatedly called for the closure of the Department and taken steps to cut its workforce and responsibilities, but cannot fully eliminate the department without an act of Congress.
In response to the president’s latest move, some House Republicans — including Reps. Kevin Kiley (R-CA) and Brian Fitzpatrick (R-PA) expressed concern that it may endanger critical educational programs. The president’s treatment of the Education Department has also received sharp criticism from teachers’ unions and civil rights groups nationwide.
