Senate focus turns to health care ahead of long-anticipated vote this week

Washington — The Senate is set to take a long-anticipated vote on a Democratic health care proposal this week, a key tenet of the deal to end the government shutdown. But the measure is unlikely to secure the necessary support to advance in the GOP-controlled Senate. 

The Senate is expected to vote Thursday on an extension of enhanced Affordable Care Act tax credits, an issue that was at the center of Democrats' demands in the shutdown fight. The vote was part of an agreement to reopen the longest government shutdown in history, which came to an end when a group of eight Senate Democrats joined Republicans to end the impasse last month. That deal included a promise from GOP leaders to allow a vote on ACA subsidies during the second week of December.

Democrats had the opportunity to present the legislation of their choice. And last week, Senate Minority Leader Chuck Schumer announced that the party will offer a clean three-year extension of the tax credits. Republicans have opposed an extension without reforms to the subsidies, which help millions of Americans pay for insurance on state-run exchanges. The credits expire at the end of the year.

Some moderate senators sought a compromise position that would stand a chance at earning the 60 votes needed to advance. Sen. Peter Welch, a Vermont Democrat who was involved in the talks, said last week that "it was an aspirational discussion, but it never got concrete."

"There was never an engaged discussion about how to extend these tax credits with specifics offered," Welch added.

The planned measure is highly unlikely to pick up support from enough Republicans, although it will force GOP members to take a politically uncomfortable vote. Schumer, a New York Democrat, has pushed back on the idea that the bill is a "nonstarter" for Republicans. 

"Thirteen votes could solve the problem. That's where the onus should be," Schumer said last week. "They can just vote for this, plain and simple."

Republicans have been highly critical of the Affordable Care Act since it became law in 2010. But with premiums set to rise in the new year with the expiration of the tax credits, some GOP lawmakers have acknowledged a need for a short-term extension.

Republicans rejected a similar, albeit shorter, extension during the shutdown. At the time, Schumer said Democrats would back a bill to quickly reopen the government if it included a one-year extension of tax credits. But GOP leaders insisted that lawmakers must reopen the government before negotiating on health care. And Senate Republicans made clear at the time that without protections for preventing taxpayer dollars from paying for abortions, the measure didn't stand a chance. The Hyde amendment, which restricts federal funding for abortions, has been among the issues at the center of the health care impasse in recent weeks.

Meanwhile, Senate Republicans have been circling their own proposal to offer alongside the Democrat-led ACA extension. The move would alleviate pressure on GOP senators, and Republicans have outlined a number of ideas aimed at addressing health insurance costs. But they have yet to coalesce behind a single approach, and may ultimately end up forgoing a bill of their own altogether. 

Some Senate Republicans have continued to engage in discussions on an extension of the tax credits with new limits on income and reforms to root out waste, fraud and abuse. But others have pushed for alternate proposals to address costs outside of the ACA framework. After President Trump voiced support for giving money directly to Americans over insurance companies, a handful of Republicans have outlined legislation to put funds into health savings accounts for consumers to use to pay for health care costs. Still, a single approach has yet to receive widespread support in the GOP conference. 

Without a plan, Senate Republicans' ideas may be pushed aside by their colleagues across the Capitol. House Speaker Mike Johnson said in recent days that House Republicans will put forward a health care proposal this week, with a plan to vote on a health care bill by the end of the year. 

"We've been saying from the very beginning, we're going to address this before the end of the year," Johnson told reporters Thursday. "There will be big developments early next week, and we're right on track."

Johnson said GOP leaders were "walking members through this" last week and would continue through the weekend, though he didn't provide details about the planned legislation. 

"The Republican Party is the party with the ideas to fix health care," Johnson said.