Dems Wary of GOP Health Negotiations   11/14 06:08

   Now that the government shutdown is over, House and Senate Republicans say 
they will negotiate with Democrats on whether to extend COVID-era tax credits 
that help tens of millions of Americans afford their health care premiums. But 
finding bipartisan agreement could be difficult, if not impossible, before the 
subsidies expire at the end of the year.

   WASHINGTON (AP) -- Now that the government shutdown is over, House and 
Senate Republicans say they will negotiate with Democrats on whether to extend 
COVID-era tax credits that help tens of millions of Americans afford their 
health care premiums. But finding bipartisan agreement could be difficult, if 
not impossible, before the subsidies expire at the end of the year.

   The shutdown ended this week after a small group of Democrats made a deal 
with Republican senators who promised a vote by mid-December on extending the 
Affordable Care Act subsidies. But there is no guaranteed outcome, and many 
Republicans have made clear they want the credits to expire.

   House Speaker Mike Johnson, R-La., called the subsidies a "boondoggle" 
immediately after the House voted Wednesday to end the shutdown, and President 
Donald Trump said the Obama-era health overhaul was a "disaster" as he signed 
the reopening bill into law.

   It is far from the outcome that Democrats had hoped for as they kept the 
government closed for 43 days, demanding that Republicans negotiate with them 
on an extension before premiums sharply increase. But they say they will try 
again as the expiration date approaches.

   "It remains to be seen if they are serious," said House Democratic leader 
Hakeem Jeffries of New York. But he said Democrats "are just getting started."

   Republicans have been meeting privately to discuss the issue. Some want to 
extend the subsidies, with changes, to avoid the widespread increases in 
premiums. Others, like Johnson and Trump, want to start a new conversation 
about overhauling "Obamacare" entirely -- a redo after a similar effort in 2017 
failed.

   Democrats push for extension

   Health care has long been one of the most difficult issues on Capitol Hill, 
marked by deep ideological and political divides. Partisan disagreement over 
the 2010 law has persisted for more than a decade, and relationships are 
already strained from weeks of partisan tensions over the shutdown.

   Connecticut Rep. Rosa DeLauro, the top Democrat on the House Appropriations 
Committee, said that while Republicans have promised negotiations and a Senate 
vote, Democrats are wary. She noted that Johnson has not committed to anything 
in the House.

   "Do I trust any of them? Hell no," DeLauro said.

   If the two sides cannot agree, as many as 24 million people who get their 
health care from the exchanges created by the law could see their premiums go 
up Jan. 1. New Hampshire Sen. Jeanne Shaheen, one of the Democrats who struck a 
deal with Senate Majority Leader John Thune, R-S.D., to reopen the government, 
said she thinks an agreement on the tax credits is possible.

   During the talks that led to the shutdown's end, Shaheen said she and other 
moderate Democrats sat across from Thune and "looked him eye to eye" as he 
committed to a serious effort.

   "We're going to have a chance to vote on a bill that we will write by 
mid-December, in a way that gives us a chance to build -- hopefully build -- 
bipartisan support to get that through," Shaheen said.

   While Democrats would like to see a permanent extension of the tax credits, 
most realize that is unlikely. Just before the shutdown ended, Senate 
Democratic leader Chuck Schumer of New York proposed a one-year extension and a 
bipartisan committee to address Republican demands for changes to the ACA. But 
Thune said that was a "nonstarter" as the government remained shut down.

   In the House, Democrats have suggested a three-year extension.

   What Republicans want

   While Republicans have long sought to scrap Obamacare, they have had 
challenges over the years in figuring out what would replace it. That problem 
plagued the 2017 effort, when then-Sen. John McCain, R-Ariz., cast the deciding 
vote to kill a bill on the Senate floor that was short on detail.

   Republican Sen. Bill Cassidy of Louisiana, chairman of the Senate Health 
Education Labor and Pensions Committee, and Sen. Rick Scott, R-Fla., have 
proposed overhauling the law to create accounts that would direct the money to 
individuals instead of insurance companies. Those are ideas that Trump echoed 
as he signed the funding bill Wednesday evening.

   "I want the money to go directly to you, the people," Trump said.

   It is unclear exactly how that would work, and scrapping the law in its 
current form would take months, if not years, to negotiate, even if Republicans 
could find the votes to do it.

   Thune has suggested that Republicans would like to see stricter income 
limits and an end to zero-cost premiums if the subsidies are extended. But 
those changes may not be enough for some in his conference who want to see the 
subsidies eliminated.

   Slow start to negotiations

   Some moderate Republicans in the House have said they want to work with 
Democrats to extend the subsidies before the deadline, which is only weeks 
away. In a letter to Thune and Schumer on Wednesday, Pennsylvania Rep. Brian 
Fitzpatrick, the Republican co-chair of the Bipartisan Problem Solvers Caucus, 
encouraged negotiations.

   "Our sense of urgency cannot be greater," Fitzpatrick wrote. "Our 
willingness to cooperate has no limits."

   So far, though, Senate Republicans have been meeting on their own to figure 
out their own differences.

   "Right now, it's just getting consensus among ourselves," Sen. Thom Tillis, 
R-N.C., said Monday after GOP members of the Senate Finance Committee met to 
discuss possible ways forward.

   Tillis is supportive of extending the tax credits, but said lawmakers also 
need to find a way to reduce costs. If the two sides cannot eventually agree, 
Tillis said, Republicans may have to try and figure out a way to do it on their 
own, potentially using budget maneuvers that enabled them to pass Trump's "Big 
Beautiful Bill" this summer without any Democratic votes.

   "We should have that in our back pocket too," Tillis said.

   Another shutdown?

   Some House Democrats have raised the possibility that there could be another 
shutdown if they are unable to win concessions on health care. The bill signed 
by Trump will fully fund some parts of the government, but others will run out 
of money again at the end of January if Congress does not act.

   "I think it depends on the vulnerable House Republicans who are not going to 
be able to go back to their constituents without telling them that they've done 
something on health care," said Rep. Pramila Jayapal, D-Wash.

   "We'll just have to see" if there could be another shutdown, said Rep. Mark 
Takano, D-Calif.

   Rep. Jim McGovern, D-Mass., said he is "not going to vote to endorse their 
cruelty" if Republicans do not extend the subsidies.

   DeLauro said that Republicans have wanted to repeal the ACA since it was 
first enacted. "That's where they're trying to go," she said.

   "When it comes to January 30 we'll see what progress has been made," she 
said.