Congress Set to End Shutdown Without Extension of ACA Subsidies

Diving brief:

• The Senate took a key step Sunday toward ending the longest government shutdown in history, voting 60-40 to move forward on a spending deal that does not include an extension of the Affordable Care Act’s more generous subsidies.
• Eight Democrats broke with their party to vote with Republicans, arguing that the lockdown had become too harmful to the American people. The defections angered some of their colleagues, given that maintaining subsidies was Democrats’ main demand in the shutdown negotiations.
• In addition to funding the government through January, the deal would also ensure that furloughed federal workers will receive back pay and that employees laid off during the shutdown will get their jobs back. Both chambers must pass the deal and President Donald Trump must sign it before the government officially reopens.

Dive overview:

The government stood idle for 41 days, jeopardizing food benefits for millions, grounding thousands of flights, and putting hundreds of thousands of federal workers, including at HHS, out of work.

Despite weeks of negotiations in the Senate, lawmakers were unable to break the deadlock on a key health policy issue that caused the shutdown: the future of expanded tax credits for ACA plans. The enhanced subsidies, which expire at the end of the year, have helped millions of Americans gain coverage on the exchanges.

But on Sunday evening, the Senate voted yes on a procedural motion to move forward with a government funding deal. The deal as it stands would not extend the enhanced subsidies. Instead, it allows the Senate to vote on those grants later in the year, which supporters of the deal say is the only way forward given that many Republicans have refused to negotiate on the grants until the government reopens.

“We must expand the ACA’s enhanced premium tax credits, but it cannot come at the expense of the millions of Americans across our country affected by a shutdown,” Sen. Catherine Cortez Masto, Democrat of Nevada, said in a statement on her vote for the deal.

However, other Democrats said the lack of progress on subsidies made it impossible to support the deal.

“America costs way too much. We will not support spending bills advanced by Senate Republicans that do not extend the Affordable Care Act tax credits. We will fight the Republican Party’s bill in the House of Representatives,” House Minority Leader Hakim Jefferies, D-N.Y., said in a statement Sunday.

Republicans are committed to voting on tax credits in December. However, this does not guarantee that an extension will be adopted. And even if an extension clears the Senate, it faces an uphill battle in the House — and a perennial critic in President Donald Trump, who spent the weekend posting on social media that the ACA is broken and that federal dollars should be diverted from “BIG, BAD” and “money-sucking” insurance companies.

“MORE MONEY, HUNDREDS OF BILLIONS OF DOLLARS, FOR DEMOCRATIC-SUPPORTED INSURANCE COMPANIES FOR REAL BAD OBAMACARE. THE MONEY NOW MUST GO DIRECTLY TO THE PEOPLE, GETTING THE ‘FAT CAT’ INSURANCE COMPANIES OUT OF THE CORRUPTED HEALTHCARE SYSTEM,” Trump wrote in an all-caps message on Truth Social on Saturday.

“PEOPLE CAN BUY THEIR OWN, MUCH BETTER POLICY, FOR MUCH LESS MONEY, SAVING AN ABSOLUTE FORTUNE FOR THEMSELVES!” continued the president.

In similar articles published the next day, Trump made it clear that he wanted the government to send money directly to Americans’ health savings accounts. Republicans are big fans of tax-advantaged accounts, which can cover qualified medical expenses, arguing that they give consumers more choice and control over their health care.

Last week, Sen. Bill Cassidy, R-La. and the chairman of the Senate Health Committee, proposed channeling ACA tax credit dollars into flexible spending accounts for eligible enrollees.

However, details are scarce on how Trump’s actual proposal would play out. Democrats rejected the idea.

“It is, unsurprisingly, absurd,” Sen. Chris Murphy, Democrat of Connecticut, said Saturday on

Despite Republican antipathy toward the ACA, voters overwhelmingly approve the expanded credits. Without them, monthly health care costs are expected to skyrocket for the millions of low- and middle-income Americans enrolled on the exchanges, and some 4 million people will lose their insurance, according to the Congressional Budget Office.

The loss of appropriations will be felt hardest in Republican districts, a source of concern for conservatives heading into a midterm year — especially after Democrats swept off-cycle elections Tuesday in states like Virginia and New Jersey.