Senate rejects competing health care bills, creating ACA subsidy expiration

The Senate voted against two competing health care bills Thursday, putting more generous financial aid for Affordable Care Act plans set to expire in just weeks.

Both bills needed 60 votes to advance. Republican legislation led by Sens. Mike Crapo, R-Idaho, and Bill Cassidy, R-La., failed after a vote of 51 to 48. The bill would have replaced the enhanced subsidies with funds sent directly to health savings accounts linked to bronze and catastrophic plans.

Senators also rejected Democrats’ plan to extend increased financial aid at its current level for three years, by a vote of 51 to 48.

Lawmakers voted largely along party lines for both measures, although Sen. Rand Paul, R-Ky., declined to support the Republicans’ HSA plan.

Senators Susan Collins, R-Maine, Josh Hawley, R-Mo., Lisa Murkowski, R-Alaska, and Dan Sullivan, R-Alaska, voted to preserve the subsidies alongside Democrats.

The failure of both bills means the enhanced subsidies will almost certainly expire at the end of the year. Premiums are expected to more than double and millions of registered should therefore abandon their coverage.

Losing the subsidies would also put pressure on providers’ finances, as a growing number of uninsured Americans would increase uncompensated care.

Enhanced financial assistance for ACA plans, first enacted during the COVID-19 pandemic, has allowed many low-income beneficiaries to pay nothing for coverage while improving affordability for middle-income enrollees.

The subsidies, which were at the center of a historically long government shutdown this fall, have become a significant issue for lawmakers. Many Republicans say the subsidies are too costly and increase opportunities for fraud, but Democrats have insisted they be extended to avoid rising health care costs.

Health sector lobbies denounced the failure of the vote in favor of extending subsidies. Margaret Murray, CEO of the Association for Community Affiliated Plans, said in a statement Thursday that the enhanced tax credits have been an “extremely effective way” to make coverage affordable, and that letting them expire would “deliberately drive up costs.”

The Federation of American Hospitals urged lawmakers to quickly find a bipartisan solution and extend the subsidies.

“As we approach the holidays, millions of Americans living paycheck to paycheck face a dire choice: go into debt so they can pay skyrocketing premiums or risk going completely without coverage,” Charlene MacDonald, executive vice president of public affairs at FAH, said in a statement. “Congress cannot leave its voters in this bind. »