With a government shutdown looming and midterms about a year away, Democratic lawmakers are itching for a fight on health care.
Democrats have successfully run on health care before, and they believe a shutdown would only amplify their message as they seek to break the Republican triumvirate in Washington.
For weeks, Democratic lawmakers have been talking about tying an extension of ObamaCare’s enhanced tax credits to government funding legislation.
If Republicans refuse to engage and the government shuts down, Democrats think Republicans will shoulder the blame. If there’s a deal on the tax credits and the government doesn’t shut down, Democrats will claim that as a win too.
“They can kind of have their cake and eat it too,” said one source familiar with the thinking of Democratic leaders.
“They can work to appease the base right now and get a meaningful policy win for their constituents from the [Affordable Care Act tax credits], but still turn around and continue getting health care to be main topic of conversation … and try to get persuadable swing voters in the midterms,” the source said.
The Trump administration has helped keep health care in the spotlight, with controversial public health directives on issues like vaccines and, most recently, painkillers for pregnant women.
As the Democratic base clamors for party leaders to fight back against the Trump administration and congressional Republicans, lawmakers see health care as the perfect pocketbook economic issue for a high-profile battle.
“We’ve been asking for this. We’ve been fighting for this. We said, if we have to fight about something … it should be about health care,” said Brad Woodhouse, a longtime Democratic strategist and president of the advocacy group Protect Our Care. “I’ll tip my cap to Senator [Chuck] Schumer [D-N.Y.] and [House Minority Leader Hakeem] Jeffries (D-N.Y.), they have drawn a line in the sand, and I think it’s the exact right thing to do.”
Without action, enhanced tax credits passed during the COVID-19 pandemic to help people afford coverage will expire at the end of the year. If they do, premiums for Affordable Care Act (ACA) enrollees will increase more than 75 percent on average, according to health policy research group KFF.
Congress has extended the enhanced subsidies twice, but now Republicans control the entire government and many conservatives are content to let them expire.
Democrats are insisting an extension be part of any short-term government funding legislation. GOP leaders appear open to the idea of some kind of an extension, likely with policy reforms attached, but they are adamant those conversations can wait until November or December.
“This is a program that needs reform, but I think everybody is willing to sit down and talk about how to make that happen in a context where it should be discussed, not as a hostage to keep the government open,” Senate Majority Leader John Thune (R-S.D.) told CNN’s Dana Bash on Wednesday.
But insurers are setting their rates now, and open enrollment for people with plans on the ACA’s exchanges begins Nov. 1. Some people are already receiving notices of substantial rate hikes. If Congress waits until the end of the year, most Healthcare.gov customers will have already selected plans.
According to the Congressional Budget Office, an enactment date later than Sept. 30 would be cheaper for the federal government, but people wouldn’t see lower premiums.
If Republicans don’t blink, Democratic strategists said a shutdown will only strengthen the Democratic position and bring even more attention to the health care debate they want to have with Republicans.
Even if Democrats manage to get Republicans to the negotiating table and hammer out an extension of the enhanced tax credits, there are a host of other health care issues that make Republicans vulnerable.
“Short of [Republicans] doing a 180 restoring Medicaid cuts, shoring up the Affordable Care Act by extending these tax credits, forcing, forcing RFK Jr. to resign … healthcare should be a big, a big issue next year, and they’re gonna pay a price,” Woodhouse said.
While no Republicans have called for Health and Human Services Secretary Robert F. Kennedy Jr. to resign, some have expressed growing concern about his moves on vaccines. President Trump spurred intense pushback himself this week by urging women to stop taking Tylenol while pregnant, telling them to “tough it out.”
During a recent press conference, Senate Minority Leader Chuck Schumer (D-N.Y.) pointed to the bigger picture of Democratic attacks, including the nearly $1 trillion cut to Medicaid that helped pay for Trump’s signature tax cut and spending law.
“It’s not just the ACA tax credits, of course. The cuts to Medicaid in the big, ugly bill. They’re closing rural hospitals and clinics. They’re closing long-term care facilities. People are losing jobs. State and local economies are suffering, and entire communities are going to be left without care,” Schumer said.
Polls show voters trust Democrats on health care more than any other issue. A recent memo from the center-left think tank Third Way urged Democrats to take advantage.
“Democrats should make health care costs their non-negotiable demand. They should refuse to participate in a bipartisan effort to fund the government unless the GOP solves the health care cost crisis they alone caused,” the memo stated.
Darbin Wofford, Third Way’s deputy director of health care, said health care is an issue that resonates.
“If these tax credits expire and Medicaid cuts go into effect, patients and providers will feel that pain through next November,” Wofford said.
