Some lawmakers see path for health care compromise after failed Senate votes

Washington — The Senate on Thursday rejected a pair of bills to address rising health care costs, with lawmakers unable to reach a bipartisan agreement on extending tax credits that help millions of Americans purchase insurance under the Affordable Care Act. 

But with the partisan exercise behind them, some senators are expressing tepid optimism about a path forward on a compromise. Lawmakers who had sought a bipartisan path forward in recent weeks have said the failed votes could be key to unlocking a deal that would extend the subsidies with reforms aimed at addressing fraud. Four Republican senators joined Democrats in voting to extend the subsidies on Thursday, hinting that an agreement might be possible.

"After we fail, I like to think we succeed," Sen. Lisa Murkowski, an Alaska Republican, told CBS News on Wednesday. Murkowski voted to extend the tax credits, along with GOP Sens. Susan Collins of Maine, Dan Sullivan of Alaska and Josh Hawley of Missouri.

The health care issue was left unresolved in the government shutdown fight earlier this fall, when Democrats sought to extend the subsidies in exchange for their votes to reopen the government. Republicans wouldn't negotiate during the shutdown. But the end of the stalemate failed to produce an agreement.

Some Republicans are open to an extension of the enhanced tax credits on a temporary basis, acknowledging the cliff that around 22 million Americans face with their expiration. But a compromise would likely need to involve reforms to the program to address income caps and fraud, along with a gradual phasing out of the credits. 

Republicans have put forward a number of ideas to address health care costs, including shorter-term extensions that impose new limits.

GOP Sen. Roger Marshall of Kansas, who introduced his own plan this week to extend the credits by one year before redirecting funds into HSA-style accounts in 2027, expressed optimism about a possible extension ahead of Thursday's votes.

"I still think we're gaining momentum every day, and I'm going to keep moving forward until someone tells me to stop," Marshall told reporters. 

But Marshall indicated he doesn't see a solution coming together before senators leave town later this month for the winter holidays.

"We can't get a Democrat to even agree on the fraud portion of our bill. And if we can't agree to address fraud, it's hard to figure out these other steps," Marshall said. "I really think we're making progress on a bipartisan basis, pointing towards a January solution."

Sen. Thom Tillis, a North Carolina Republican, outlined a shorter timeline to reach a compromise, saying that Democrats will use the coming price hikes as a key political issue heading into the midterm elections.

"Now is the time to get it done," Tillis told CBS News. 

Tillis said Senate Democratic leaders likely aren't interested in a compromise, since "they see the political opportunity this represents." But among the rank and file, the North Carolina Republican said he expects a  "sufficient number" would support an extension that addresses fraud. He pointed to a proposal by Collins, which would extend the tax credits for two years and include income caps. 

Ahead of the votes, Tillis said the partisan measures needed to fail before some Democrats might be willing to reach a compromise. 

"It's amazing, sometimes, what can get done in a week," Tillis said. "But we have a week."

Sen. Jeanne Shaheen, a New Hampshire Democrat who negotiated the deal with Republicans to end the shutdown last month, also indicated openness to a compromise. 

"I'm ready to come to the table and I think we would be better served if after we get through these votes, we sit down and come to a compromise to address the real costs that people are facing in terms of health care," Shaheen said on the Senate floor Thursday. "And I'm ready to do that."

Shaheen acknowledged the ideas put forward by Republicans, calling the engagement "constructive." But she stressed that time is short to extend the tax credits.

"I know there are members in both parties who want to find a responsible path forward," she said. "I welcome the discussion on where we can find common ground… But first we must keep millions of Americans from losing coverage in the coming months."

Even Senate Majority Leader John Thune wouldn't rule out an extension of the tax credits in the near future. 

"The question is, are there enough Democrats who actually want to fix the problem, to work with the Republicans, a lot of us, who want to fix the problem? Or are they going to succumb to their leadership and probably where their far left base is and just want to make this a political issue?" Thune said. 

The South Dakota Republican said "if you did something with reforms and structured this program differently so it puts downward pressure on premium instead of upward pressure, I think you could do something."

Thune said that conversations are ongoing between rank-and-file members on both sides who have "an interest in solving it." 

There has been chatter on Capitol Hill about Republicans opting to go it alone on health care using reconciliation, which would allow them to approve changes with a simple majority. Thune said he wouldn't rule anything out, but said he prefers a bipartisan approach.

"If we could do something at 60, those results tend to be, you know, more durable over time … but I wouldn't rule anything out," Thune said.

The optimism around a bipartisan path forward in the Senate comes as a number of Republican moderates in the House have started to buck GOP leaders and try to force a vote on their own proposal. House Republicans in vulnerable districts have been sounding the alarm about the political consequences of failing to address the coming price spikes. But Speaker Mike Johnson has indicated he would not bring an extension of the tax credits up for a vote, saying the majority of the GOP conference does not support the move.

On Wednesday, moderate Republicans filed a discharge petition aimed at requiring a vote on a bill to extend the ACA subsidies. Some of them also support a Democratic petition to compel a vote. The petitions would require 218 signatures to bring the underlying bills to the floor, and both have already accumulated enough Republican support that they would succeed if all Democrats sign on.

Murkowski pointed to the slew of recent proposals from across the Capitol as evidence of shared interest in finding a solution. 

"Look at the various proposals out there. Whether it's the all-Democrat proposal here or the bipartisan proposals over in the House or the all-Republican proposals over here — there's a lot of shared elements, right," she told CBS News. "There's a lot that's out there that we just need to cobble together into one package that makes sense, recognizing that it's going to be short-term, and go from there."

Asked why it hasn't happened yet, Murkowski told reporters "I don't know."

"I guess we have to demonstrate our failures first before we can applaud our successes," she said.