An estimated half million Alabamians could see the cost of their healthcare jump by up to twenty five percent as soon as today. The Kaiser Family Foundation website says that’s how many Alabamians are covered by the Affordable Care Act, also known as Obamacare, and by how much the cost of that coverage may increase with the expiration of federal subsidies. That apparently doesn’t include the number of state residents who will lose their health insurance altogether.
There’s a chance that Congress may still act, but maybe not fast enough to stop the price hike caused by the end of the subsidies. The U.S. House reconvenes on January 5th. That’s the soonest the lower chamber could vote following action by Four centrist Republicans who broke with Speaker Mike Johnson and signed onto a Democratic-led petition that will force a House vote on extending for three years an enhanced pandemic-era subsidy that lowers health insurance costs for millions of Americans. Debbie Smith is the campaign manager for the Cover Alabama program at Arise Alabama. She says high costs from the end of the ACA subsides could also hit hospitals and the insured..
“I'm really worried that a lot of people who are using healthcare.gov, for their insurance, are no longer going to be able to afford their insurance and are just going to drop it all together and become uninsured. But I'm also concerned about the overall market impact,” she said.
Alabama Arise is worried that that impact could include rural hospitals that depend on revenue that comes from treating patients using the Affordable Care Act. The Kaiser Family Foundation estimates that 193,000 Alabamians could close their healthcare coverage. Debbie Smith with Alabama Arise says that may not stop people without coverage from seeking care, even if they can’t pay.
“I'm really worried that as more uninsured people go into the hospital, go into clinics without being able to pay their bills because they're uninsured, that some of those costs are going to be passed on to other individuals,” she said.
The stunning move on Capitol Hill last month came the same day that House Republican leaders pushed to passage a health care bill that does not address the soaring monthly premiums that millions of people will soon endure. The developments set the stage for a renewed intraparty clash over health care in January, something Republican leaders had been working hard to avoid.
The moderate Republicans were able to force the issue by signing a petition, led by Democratic leader Hakeem Jeffries of New York, to vote on a bill that would extend the ACA subsides for three years. Republican Reps. Brian Fitzpatrick, Robert Bresnahan and Ryan Mackenzie, all from Pennsylvania, and Mike Lawler of New York signed on Wednesday morning, pushing it to the magic number of 218. A vote on the subsidy bill could come as soon as January under House rules.
“Unfortunately, it is House leadership themselves that have forced this outcome.” Fitzpatrick said in a statement.
Johnson told reporters Wednesday that “I have not lost control of the House” and he noted that Republicans have a razor-thin majority that allows a small number of members to employ procedures that would not usually be successful in getting around leadership.
“These are not normal times,” said Johnson, R-La.
The revolt against GOP leadership came after days of talks centered on the health care subsidies.
Johnson had discussed allowing more politically vulnerable GOP lawmakers a chance to vote on bills that would temporarily extend the subsidies while also adding changes such as income caps for beneficiaries. But after days of discussions, the leadership sided with the more conservative wing of the party's conference, which has assailed the subsidies as propping up a failed ACA program, which is widely known as “Obamacare.”
House Republicans pushed ahead on a 100-plus-page health care package without the subsidies. Instead, the measure focused on long-sought GOP proposals designed to expand insurance coverage options for small businesses and the self-employed. The bill passed on a mostly party-line vote of 216-211. Rep. Thomas Massie, R-Ky., joined with Democrats in voting against the measure.
Fitzpatrick and Lawler tried to add a temporary extension of the subsidies to the bill, but were denied.
“Our only request was a floor vote on this compromise, so that the American People’s voice could be heard on this issue. That request was rejected. Then, at the request of House leadership I, along with my colleagues, filed multiple amendments, and testified at length to those amendments,” Fitzpatrick said. “House leadership then decided to reject every single one of these amendments."
“As I’ve stated many times before, the only policy that is worse than a clean three-year extension without any reforms, is a policy of complete expiration without any bridge," Fitzpatrick said.
Lawler, in a social media post, similarly said that “the failure of leadership” to permit a vote had left him with “no choice” but to sign the petition.
“I don’t like them. It’s not the way it’s supposed to work,” Johnson said of the discharge petitions.
Jeffries, for several weeks, had called on Republicans to sign his discharge petition. He particularly challenged Republicans in competitive congressional districts to join the effort if they really wanted to prevent steep premium increases for their constituents.
“Our position from the very beginning was that we are standing on the right side of the American people who want to see the Affordable Care Act tax credits extended, and we’re appreciative that we now have the bipartisan coalition to get that done," Jeffries said.
The GOP holds a 220-213 majority in the House, which means defections from just a sliver of the conference can upend leadership's plans. Johnson has been able to negotiate that challenge largely by making accommodations to the more conservative wing of his conference. This time, it was the moderates who revolted.
The defectors largely represent districts that Democrats have targeted in their bid to retake the majority, with Democrats promising to make health insurance costs a central issue in next year's midterms.
Lawmakers turn to discharge petitions to show support for an action and potentially force a vote on the House floor, but they are rarely successful. This year has proven an exception. The vote requiring the Department of Justice to release the Jeffrey Epstein files occurred after Reps. Ro Khanna, D-Calif., and Massie introduced a petition to force a vote on the Epstein Files Transparency Act. The signature effort was backed by all House Democrats and four Republicans.
It was a long battle to get 218 signatures, but once the magic number was reached, lawmakers in both chambers voted overwhelmingly for the bill.
Even if the Democrats' subsidy bill were to pass the House in January, which is far from assured, it would face an arduous climb in the Republican-led Senate. Republicans last week voted down a three-year extension of the subsidies and proposed an alternative that also failed. But in an encouraging sign for Democrats, four Republican senators crossed party lines to support their proposal.
Senate Majority Leader John Thune, R-S.D., argued against the Democratic extension as “an attempt to disguise the real impact of Obamacare’s spiraling health care costs.”
Senator Thom Tillis, R-N.C., said he viewed the House developments Wednesday as a positive for generating a compromise that both parties could support.
“If we're not talking, we're not making progress. This continues the discussion,” Tillis said.
Senate Democratic leader Chuck Schumer of New York said that the 218th signature for the Democrats' bill showed that the demand from the American people for an extension is undeniable, but “the damage has now been done, no matter what happens.”
“Because at this point, Republicans have made it impossible to prevent many Americans from paying more on their monthly premiums on January 1st. And Republicans can’t even say they tried to stop it,” Schumer said.
