The Senate on Thursday deadlocked on competing proposals to avert rising health care premiums, blocking Democratic and Republican alternatives in an outcome that made it all but certain that expanded tax subsidies for health coverage under the Affordable Care Act will expire at the end of the month.
Republicans squelched a bid by Democrats, who had demanded action on the issue during the 43-day government shutdown, to extend the insurance subsidies for three years.
Democrats turned back a Republican alternative that would replace the subsidies with an expansion of tax-advantaged health savings accounts and direct payments of up to $1,500 to people who buy the most basic health insurance plans.
Neither proposal could muster the 60 votes necessary to overcome a filibuster and move ahead, a long-expected result that teed up a brutal battle over health care that is likely to shape the fight for control of Congress next year.
Both plans were thwarted on separate votes of 51 to 48. Four Republicans — Senators Josh Hawley of Missouri, Susan Collins of Maine and Lisa Murkowski and Dan Sullivan, both of Alaska — joined Democrats in support of taking up the extension, while all Democrats and a single Republican, Senator Rand Paul of Kentucky, opposed the G.O.P. alternative.
With Congress set to leave for the holidays after next week and the two sides still far apart on their approach to rising health insurance costs, time was nearly out to renew the premium subsidies that millions of Americans depend on to afford coverage on the federal health care exchange. Democrats have promised to spotlight the issue in midterm election campaigns, seeing an opening to pound Republicans for failing to head off sharp premium increases and threatening health care access at a time when many Americans are toiling to afford basic necessities.
Republicans said Democrats’ bid to preserve the subsidies would simply maintain a “bloated” federal program that was meant to be temporary and is experiencing unsustainable costs. They said a new Government Accountability Office investigation also found that the program is susceptible to fraud that has contributed to insurance company profits.
“The Democrat proposal, which is a three-year extension of the status quo, is an attempt to disguise the real impact of Obamacare’s spiraling health care costs,” said Senator John Thune, Republican of South Dakota and the majority leader. “If we extend this three years at a cost of $83 billion to the taxpayers, what happens after three years?”
Democrats said that the Republican proposal amounted to an inadequate “coupon” for health care, noting that it would go only to those who purchased high-deductible insurance plans that require people to pay thousands of dollars for medical care before receiving coverage. They argued it would do nothing to head off the immediate threat of rising premiums, harming Americans who could lose coverage and be unable to afford needed care.
“The whole conversation about these Affordable Care Act tax credits in this town, in this building, has been focused on the politics of this issue,” said Senator Jon Ossoff, Democrat of Georgia. “This is life or death. People will die.”
Republicans said the root cause of the escalation in health insurance premiums was the Affordable Care Act, the health insurance program established by Democrats during the Obama administration.
“Democrats know that Obamacare has failed,” said Senator Mike Crapo, Republican of Idaho and one of the authors of the Republican plan. “Their only offer is more spending.”
Republicans had committed to allowing Democrats a vote on their proposal to extend the health care subsidies as a condition of a deal to end the government shutdown.
The G.O.P., which has struggled for years to coalesce around a health care plan, had considered not offering an alternative to the Democratic proposal. But party leaders faced pressure to put a plan forward so Republicans could say they had tried something to address the expiring tax subsidies.
House Republicans have said they will next week begin considering some piecemeal measures that represent their approach to addressing rising health care costs, but an extension of the subsidies is so far not part of the mix. As a result, a group of House Republicans worried about the political backlash from allowing the breaks to expire started a petition on Wednesday to try to force a floor vote.
The White House has taken a largely hands-off approach to the congressional health care fight after President Trump initially suggested he would back a limited extension of the subsidies but was quickly urged by Republicans on Capitol Hill to drop that push.
Members of both parties said they still wanted to try to reach some solution even though bipartisan negotiations have come up empty so far.
“I’m ready to come to the table,” said Senator Jeanne Shaheen, Democrat of New Hampshire. “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.”
Carl Hulse is the chief Washington correspondent for The Times, primarily writing about Congress and national political races and issues. He has nearly four decades of experience reporting in the nation’s capital.
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