Undaunted

The House votes to advance extension of ACA subsidies

If Donald Trump thought that launching an endless military operation against Venezuela and using the U.S. military and taxpayer dollars to plunder oil would improve his political standing, he may have miscalculated. Democrats — with the aid of a remarkable 17 Republicans — voted to extend the Affordable Care subsidies for three years. It seems at least some Republicans on the ballot this year seemed to have had second thoughts about taking healthcare away from tens of millions of Americans.

While most pundits have predicted any House measure would die in the Senate, a bipartisan compromise now looks possible, especially given the margin in the House. Politico and other outlets have reported a potential deal for a 2-yr. extension, a requirement for a minimum premium, and finding some way to “finesse” on Hyde Amendment abortion restrictions. If this results in a deal, it would represent a stunning rebuke of Trump and MAGA Republicans who provoked a shutdown by refusing to extend the subsidies.

Credit should go in large part to Minority Leader Rep. Hakeem Jeffries (D-N.Y.) who kept the focus on healthcare, maintained his nerve during the shutdown, and continued to make the case to voters even after Senate Democrats caved. Had he not done so, the issue would not now be front and center, causing Republicans fits. Jeffries has shown that the minority certainly has cards to play.

Republicans must decide if they really want to be responsible for the consequences of letting the subsidies expire. “Since the subsidies were first expanded in 2021, allowing more people to qualify and lowering their payments, millions of Americans have benefited,” the New York Times reported earlier this week. “A record 24 million people enrolled in Obamacare for 2025, with a vast majority receiving some tax credits.” These were disproportionately red state residents, many self-employed or working for a small employer exempted from providing insurance. (In other words, Republicans.) Without those subsidies, the cost of coverage will “more than double, increasing by hundreds or even thousands of dollars a month.”

Many people will roll the dice and go without coverage. Others will choose a high-deductible plan, praying they do not rack up thousands of dollars in medical costs before insurance kicks in. And millions will defer or go without car repairs, a new house, a family trip, or other major purchases. Credit card debt likely will rise for families stretched thin. Personal bankruptcies will become more common—just as they were before the Affordable Care Act went into effect.

Instead of facing the problem head-on and continuing the subsidies or coming up with a concrete alternative, Donald Trump has been arm-twisting drug companies to lower some prices, to simplify pre-authorization procedures, and to form a coalition “with more than 60 providers, payers and software companies to improve electronic patient information sharing and give consumers better digital tools to use to navigate the health system and public programs,” KFF’s Drew Altman explained. Trump (no surprise!) vastly exaggerates the impact of these items.

Altman notes Trump’s pattern: “jawbone, negotiate in some fashion, make a deal, keep it simple and understandable to voters, and announce it with fanfare and usually lots of exaggeration, with no broader plan and without addressing the underlying causes of the problem.” However, side deals will not remotely “offset the combined impact on the public of the nearly trillion dollars in Medicaid cuts that will kick in over the next 10 years and the premium spikes that will hit Marketplace enrollees if the enhanced tax credits are not extended.”

Trump also has talked about convening a grand meeting to get insurance companies voluntarily to cut prices by up to 70% (!). This is silly, even for Trump. Who actually thinks insurance companies are going to give up that much revenue? (Voluntary price restraint from insurance companies has not worked in the past, you might not be surprised to hear.)

Now, Trump may be betting that he can “negotiate” with insurance companies in the same way he does with Congress and foreign countries. We know that “negotiation” for Trump usually entails bullying and threats. Nice country you got there. Shame if anything happened to it. In other words, rather than do the effective, popular thing (extend the subsidies, just as Democrats wanted) he is banking on threats and theatrics to make himself look good.

Republicans in Congress surely understand that will do nothing to save their skins in the midterms. Facts, including family expenses, are stubborn things. With Trump’s popularity sinking like a stone, Republicans got slammed in the November elections because Americans know Trump’s groundless boasts and undeserved self-congratulations have nothing to do with their lived experience. As Americans find it harder to make ends meet, they will have no difficulty figuring out who is responsible for their pain.

Now focus turns to the Republican Senate. Do they want to be the villains on healthcare? If they choose not to be, Jeffries will still have succeeded in raising the issue and putting Republicans in a precarious position. Republicans are now in a no win situation: put themselves at risk with the voters or defy the MAGA base.

Legacy media pundits keep insisting Democrats have little to no chance to win the Senate. But if Republicans play the spoiler, voters will be reminded that Republicans refused to spare them thousands of dollars in increased cost, possible loss of coverage, and untold stress. (Incidentally, Democrats chances of winning the Senate increased with news that former Alaska Democratic congresswoman Rep. Mary Peltola, perhaps the only Democrat who can knock out Republican Sen. Dan Sullivan, is making plans to run.)

In short, as in 2017 when Republicans controlled both houses of Congress and the White House and tried to repeal the ACA, Democrats have a chance to pull off another policy and political achievement. Again, credit should go to Jeffries, who remained undaunted, unbowed, and unrelenting in his effort to save healthcare insurance for millions of Americans.

Hmmm. Maybe Republican did not actually “win” the shutdown.