SCOTT DETROW, HOST:
Insurance premiums for millions of Americans are set to spike at the end of this year when enhanced subsidies for the Affordable Care Act are set to expire. Today, the Senate voted on dueling plans to address health care costs, and both of those measures failed. NPR congressional reporter Sam Gringlas was tracking the votes today on Capitol Hill. Hi, Sam.
SAM GRINGLAS, BYLINE: Hey, Scott.
DETROW: Remind us how we got here.
GRINGLAS: So Democrats have been pushing for months to get these enhanced subsidies extended. This fall, they withheld their votes on a funding bill to reopen the government as they pressed to preserve the subsidies. Republicans, though, they did not relent, and enough Senate Democrats ultimately agreed to end the shutdown in exchange for a vote on the subsidies, which is what happened today.
DETROW: OK. So we mentioned two different proposals. What were they?
GRINGLAS: Senate Democrats united behind a three-year clean extension of the subsidies. Democrats like Senator Jon Ossoff of Georgia warned about the consequences of letting them expire. He talked about one constituent with diabetes who had just had a major surgery and said she's going to have to cancel her insurance because of the exploding premium.
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JON OSSOFF: And she cried again when she got that insurance quote because suddenly she feared that she might die. She might die.
GRINGLAS: Now, some Republicans are also worried about the subsidies expiring, you know, at a moment when affordability is a key concern for a lot of voters. Four Republicans voted with Democrats on this bill - not enough to pass it, though. I spoke to one of those Republicans, Senator Josh Hawley of Missouri.
JOSH HAWLEY: The politics - I just - I don't know. I'll leave that to others. But I do know that - the effect on people at home. And right now, people at home are saying we need our health care prices to be lower. They need help on everything. So I'm for doing everything that will help lower the cost of health care.
GRINGLAS: So Hawley voted for the Democratic and the Republican plans.
DETROW: Right. There was so much of a focus on the Democratic plan after the shutdown. Tell us about the Republican one that was also up today.
GRINGLAS: So that plan would have put up to 1,500 bucks a year in health savings accounts for people on high-deductible ACA plans, making up to 700% of the federal poverty line. The money could be used for things like copays and medicine but not for premiums. Republican Senator Bill Cassidy of Louisiana helped craft that plan, and he said it would give money directly to people, not the insurance companies.
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BILL CASSIDY: If the average American family has less than a thousand dollars to spend, and our plan puts thousands in their account to pay for the health care they know they need, what is the objection to that?
GRINGLAS: Now, Democrats argued that families may still not be able to afford the coverage in the first place. They also noted this bill would have penalized insurance companies for covering abortion and prevented Medicaid and the Children's Health Insurance Program from covering gender-affirming care. So this vote also failed.
DETROW: This is all the Senate. What's been going on in the House?
GRINGLAS: House Speaker Mike Johnson has said there is a plan coming, but it has not surfaced yet. There are a couple of rank-and-file bipartisan proposals in the works that would extend the subsidies temporarily, along with some reforms. These bills could be brought to the floor by maneuvering around the leadership but would probably need unanimous Democratic support plus enough Republicans to really have a shot.
DETROW: Congress has been debating and arguing the Affordable...
GRINGLAS: Yeah.
DETROW: ...Care Act for years now.
GRINGLAS: Yeah.
DETROW: How does this fight over extending these subsidies fit into all of that?
GRINGLAS: The Affordable Care Act has been controversial from the jump. Republicans have tried over and over to repeal it but have struggled to come up with an alternative. Now, many acknowledge that the ACA is here to stay, even as they continue to criticize it as, you know, the Unaffordable Care Act, though polling, Scott, has shown that the ACA subsidies are incredibly popular with voters across party lines.
DETROW: What happens next?
GRINGLAS: There are some other plans by different Senate Republicans and some informal bipartisan Senate talks have been happening. Those members hope these failed partisan votes may reignite those efforts, but the chances - they still look pretty dim. And President Trump said this week he is not keen on doing health legislation at all. In the meantime, these enhanced subsidies are still set to expire, meaning health care could animate the upcoming midterms, and people are making decisions right now about whether they can keep their coverage next year.
DETROW: Yeah. That is NPR congressional reporter Sam Gringlas. Thank you so much.
GRINGLAS: Thanks, Scott. Transcript provided by NPR, Copyright NPR.
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