The White House’s health care proposal faces familiar divisions in the Republican Party

WASHINGTON (AP) — A health care proposal circulated by the White House in recent days faces the reality of Republican divisions on the issue — a familiar conflict for a party that has been trying to repeal or reform the Affordable Care Act for the past 15 years.

The initial proposal from President Donald Trump would extend expiring ACA benefits for two years while adjusting eligibility requirements for recipients. The plan has so far been met with silence on Capitol Hill, as Republicans debate among themselves whether to fix the law, amend it, or simply let the benefits expire.

It’s not clear right now when the White House plan might be released, or if it will be released at all.

Republican hesitation comes as coronavirus-era tax breaks are set to expire on January 1, leading to sharp increases in insurance premiums for millions of Americans. Democrats, who shut down the government for six weeks over the issue, are demanding a direct extension without any changes, though some have indicated they might support a plan similar to the one circulated by the White House.

But support may be hard to find at the GOP convention, where many lawmakers say costs are still too high and were eager to make another push to repeal the Affordable Care Act. The last effort failed in 2017 when Republicans couldn’t decide how to provide coverage to millions of Americans who rely on government-run marketplaces for their health care. It’s an ongoing dilemma for the party after setting record numbers for coverage this year.

Senate Majority Leader John Thune promised a group of moderate Democrats to vote on the Affordable Care Act tax credits by mid-December in exchange for their votes to end the government shutdown. But it is not yet clear whether this arrangement will lead to a solution.

Bipartisan compromise?

Health care has long been one of the most politically charged topics on Capitol Hill, so a bipartisan compromise seems unlikely. But the upcoming price hikes have prompted some lawmakers to search for points of agreement.

Republican Sen. Thom Tillis of North Carolina said last week that he hoped the support would be extended.

“I’m sure some of my colleagues are going to be mad at me for saying this — if we don’t address the subsidy issue in December, I don’t think it’s going to be addressed next year,” Tillis said, adding that Democratic campaigns are “just going to spin all the very sympathetic stories” if it’s not fixed.

A draft White House proposal would set new income limits on tax credits — at 700% of the federal poverty level, according to two people familiar with the proposal who requested anonymity to discuss it. The White House will also require those who take advantage of Obamacare, regardless of type of coverage, to pay some type of premium for their plans. That would effectively end zero-premium plans for low-income people, addressing concerns from Republicans who say the program has enabled fraud.

Read more: The White House is circulating a plan to extend Obamacare support as Trump pledges to reform health care

Some Democrats have indicated they are open to these ideas as part of broader negotiations. “I’m glad the president is considering a serious proposal,” said New Hampshire Senator Jeanne Shaheen, one of the Democrats who voted to end the shutdown.

Some Republicans have shown their support as well. Nebraska Rep. Mike Flood, chairman of the business-oriented GOP caucus, said in a statement that the group supports President Trump’s “continued efforts to address the ACA tax credit cliff while extending it.”

Several bipartisan bills introduced in the House would extend the ACA appropriations by two years, with changes such as income limits for the enhanced credit. “I think two years is really a time where everyone is OK,” said Pennsylvania Rep. Brian Fitzpatrick, co-chair of the bipartisan Problem Solvers Caucus.

Premiums rise on January 1

However, House Speaker Mike Johnson, R-Los Angeles, declined to say whether he would allow a vote on the health care bill. Many other members of the GOP conference want to eliminate subsidies or reform the statute. Additionally, Thune and other Republicans have said they want new language on abortion restrictions if they agree to an extension, which is a deal-breaker for Democrats.

If Congress does not act, the enhanced tax credits that helped many Americans pay for health insurance plans under the Affordable Care Act will disappear. Premiums could double for subsidized enrollees, according to an analysis by the health care research nonprofit KFF.

Signing up for insurance for next year began Nov. 1, which means many Americans are already planning to take on the higher costs. Democrats who imposed the shutdown at the beginning of October had hoped to negotiate an extension before open enrollment began.

“When people’s monthly payments go up next year, they’ll know that Republicans did it,” Senate Democratic Leader Chuck Schumer said last week.

Republicans can do it alone

While Democrats raised the issue of health care during the shutdown, some Republicans saw an opportunity to renew their efforts to reform the law. GOP lawmakers in the House and Senate are meeting to reach a consensus, although they have not reached it yet.

Among the GOP ideas are separate proposals from Florida Sen. Rick Scott and Louisiana Sen. Bill Cassidy to use savings accounts to either shop for insurance or defray out-of-pocket costs. Scott’s legislation would create what he called “Trump Health Freedom Accounts” and make some changes to the health care law, including by allowing consumers to shop across state lines. Cassidy’s narrower bill would create new savings accounts only to replace enhanced subsidies that expire.

Meanwhile, the White House draft plan would allow those in lower-tier plans, such as bronze-level or catastrophic plans, to put money into health savings accounts.

These proposals are unlikely to be accepted by Democrats. Schumer said last week that savings accounts “are not going anywhere in the Senate.”

Skeptical that the two parties can ever agree, some Republicans have suggested they try to pass the health care package using budget maneuvers similar to Trump’s proposed “big, beautiful bill” to cut taxes and spending. If successful, they could pass the legislation without Democratic votes — a politically risky strategy that could take months, even in a midterm election year.

It all depends on Trump

Some Republicans may be waiting for clear direction from Trump, who has been sending mixed signals about what he wants.

For weeks, Trump has appeared to support savings accounts on social media, most recently posting on November 18 that “the only healthcare I will ever support or approve of is sending money directly to the people, with nothing going to the big, rich insurance companies, who have made trillions of dollars, and have been ripping America apart for long enough.”

He added: “Congress, do not waste your time and energy on anything else.”

Trump repeated this message Tuesday evening.

“Don’t give money to insurance companies,” he told reporters Tuesday evening. “You give money to people.”

Associated Press writers Seung-Min Kim, Joey Cappelletti and Kevin Freking in Washington and Ali Swenson in New York contributed to this report.