Republicans scramble for health care plan, as Democrats eye midterm battle

By Sarah Ferris, Adam Cancryn, CNN

(CNN) — Republicans in Washington successfully defused the 43-day government shutdown without surrendering to Democrats’ demands to spend billions more to offset spiking health insurance costs.

Now, the GOP is under mounting pressure to figure out its own plan.

Enhanced Affordable Care Act subsidies are set to expire in just weeks – which would more than double the cost of premiums nationally for tens of millions of Americans. And it’s causing deep anxiety among some in the party, particularly in battleground seats, who worry Republicans will end up doing nothing to prevent those price hikes and enter a critical midterm year with the issue of health care haunting them once again.

GOP leaders in the House have begun work on their own package, which is unlikely to extend those subsidies and instead will seek other ways to reduce costs, according to multiple people familiar with the discussions. But Republicans are not committing to doing anything on health care by December 31, when those subsidies expire and premiums are set to spike.

Inside the White House, officials are accelerating efforts to put together a new health care plan that fulfills President Donald Trump’s desire to take another shot at overhauling Obamacare.

Those early discussions have sought to balance Trump’s demands against the broader Republican Party’s wariness of waging another politically disastrous health care war, four people familiar with the matter said. Officials are debating a limited package of conservative health care changes, including eliminating the enhanced ACA subsidies in favor of funneling money directly to Americans — potentially through an expansion of health savings accounts.

Democrats, meanwhile, are closely watching the GOP’s plans, which they believe will never pass Congress – giving them a huge political boost and possibly delivering them control of the House in 2027.

The uncertainty of the GOP’s plans is fueling anxiety for Republicans like Rep. Jeff Van Drew, the outspoken populist from New Jersey who has repeatedly urged party leaders to give some relief for those Obamacare premiums or face voters’ wrath next November.

“There’s a whole bunch [of ideas] that are out there,” Van Drew said, ticking off proposals such as Trump’s idea to give money directly to consumers to buy plans. “The question is, can we get them done on time, to really not hurt people in the United States of America?”

There’s another reason Van Drew is worrying. Time is running short and he said GOP leaders have been tight-lipped on their plans: “A lot of members haven’t seen any of this.”

He isn’t the only one sounding the alarm. Rep. Marjorie Taylor Greene of Georgia — who has drawn the ire of Trump himself for her criticism of the party — has been repeatedly warning of a health care catastrophe of the GOP’s own making if Congress doesn’t act.

“Here’s my problem. Republicans have never fixed it,” Greene said of Obamacare in an interview with “The Sean Spicer Show.” She said Republicans need to act to make sure “the American people aren’t driving 80 miles per hour off a brick wall and hitting a financial crisis which is what’s actually happening.”

Among the GOP’s leadership ranks, there’s an acknowledgement they need to do something on health care affordability. But those party leaders are also staunchly opposed to renewing those subsidies, which they insist simply funds insurance companies and props up a failed law.

Instead, House GOP leaders are assembling their own slate of health care bills — though exactly which ones have yet to be determined.

“We’re pulling together the best ideas that we can, in the quickest fashion, to bring premiums down,” Speaker Mike Johnson told reporters Wednesday night, the same day the House returned from a six-week recess during the shutdown.

White House aides have similarly indicated that they will soon have a concrete plan, insisting that the administration plans to play a central role in directing the GOP’s health care strategy amid deepening concerns over Trump’s standing on the economy and affordability issues.

In addition to further expanding health savings accounts, officials have weighed a range of existing conservative policy ideas aimed at expanding patients’ health care options and lowering costs — including loosening certain Obamacare guardrails and giving states greater flexibility to customize their health insurance marketplaces.

Yet many of those proposals have proven unpopular with voters in the past, and fall well short of Trump’s vow to “forget this Obamacare madness” altogether. And as the midterm outlook worsens for the GOP, some in the party still plan to push for a simpler compromise on the subsidies.

There are at least a dozen House Republicans who do support temporarily extending the Affordable Care Act subsidies, many of them from battleground districts that will be key to GOP control of the chamber next year. Virginia Republican Rep. Jen Kiggans has been particularly vocal on the issue, drafting a bill to extend the subsidies for one year that’s gotten a dozen GOP cosponsors.

Kiggans and her cosponsors are already working to plot a path forward: Staff of several of those members on the bill will meet Thursday to discuss next steps, according to a source familiar with the plans.

Another swing-seat Republican backing the bill, Rep. Brian Fitzpatrick of Pennsylvania, sent a letter to Senate leaders Thursday seeking bipartisan talks to work on a bill extending those Obamacare subsidies.

But even some House moderates privately acknowledge that it’s unlikely any provision that upholds Obamacare can pass the GOP chamber. Even if the bill would win Democratic votes, GOP leaders know there is fierce resistance to any Obamacare bill and would refuse to put it on the floor.

Trump has also grown increasingly opposed to continuing the subsidies despite the political peril, with one of the people familiar with the matter characterizing the president as “on fire” over the issue. Though administration officials during the shutdown’s first weeks had weighed supporting a short-term extension that would phase out the subsidies over time, that idea has since appeared to lose steam, the people familiar with the matter said.

Trump in recent days has instead repeatedly disparaged the tax credits as a “disaster” and latched onto arguments made by conservative allies that they largely amount to a windfall for insurance companies.

Rep. Jim Jordan, the influential House Judiciary chairman, for instance, entirely dismissed the idea of extending the subsidies when pressed by CNN if he could accept any plan that kept them in place.

“If Obamacare was so wonderful, why do we need to keep extending the expanded subsidies?” the Ohio Republican said. ”This is an expansion of Obamacare.”

House Majority Leader Steve Scalise, too, argued that any extension of the subsidies would be simply a move to “prop up a failed Obamacare fund.”

“The Affordable Care Act has failed miserably at being affordable. That is a broken model. We want to give people options that lower their premiums, not just shovel more money to insurance companies,” he said.

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CNN’s Linda Gaudino contributed to this report.