MICHEL MARTIN, HOST:
House Republicans want to force a vote that would extend Obamacare health insurance subsidies that are set to expire in less than three weeks.
STEVE INSKEEP, HOST:
They're warning their own party's leaders that Republicans risk losing their majority in next year's elections if they let subsidies expire without a replacement. So far, House leaders have not scheduled a vote. The Senate has. Senators today consider two health policy plans each aimed at reducing health care costs for those who buy their insurance on HealthCare.gov. In a moment, we will speak with one of the senators who will be voting Democrat Jeanne Shaheen. First, we have the facts.
MARTIN: NPR's Selena Simmons-Duffin is here to explain. Good morning, Selena.
SELENA SIMMONS-DUFFIN, BYLINE: Good morning, Michel.
MARTIN: So, Selena, you met somebody who illustrates the dilemma here for the vast majority of the 24 million people who get their health insurance through the exchange. Tell me about her.
SIMMONS-DUFFIN: Yeah. Her name is Ellen Allen (ph). She lives near Charleston, West Virginia, and I first talked to her over the summer. She's 64 years old. She was raiding her retirement savings to prepare for a huge increase in her premium. And when I reached her yesterday, she told me she'd enrolled in a plan.
ELLEN ALLEN: The bronze plan without vision and dental, with a monthly premium of $1,967.50
SIMMONS-DUFFIN: So her premium for 2026 is four times this year's premium, nearly $1,500 more every single month for a plan that covers less.
MARTIN: So that's going to happen unless Congress steps in and changes the law. So what could that look like?
SIMMONS-DUFFIN: Senate Democrats are expected to vote on a bill today that would extend the enhanced subsidies that were bringing costs down for three years. The bill would also extend open enrollment until May and do several other things, like allowing automatic renewals and renewing funding for people who help you sign up. Republicans don't like this plan. They say it's too expensive. It's driving health care costs up. And they point to reports of fraud to say the whole system is flawed.
MARTIN: So it seems like the Republicans took a while to coalesce around an alternative, but they did. What's their idea?
SIMMONS-DUFFIN: This bill would not address those rising premium costs directly. It would instead put taxpayer dollars into health savings accounts for some enrollees - a thousand dollars a year for people under age 50 and $1,500 for people between 50 and 64. That money could not go towards premiums, but it could go to other kinds of health expenses like copays or over-the-counter medications, and it would also prohibit abortion coverage in Obamacare and prevent Medicaid from covering gender affirming care for transgender people of any age. Democrats don't like this bill at all, and neither does Ellen Allen.
ALLEN: A thousand or $1,500. I mean, I understand that's not a monthly contribution.
SIMMONS-DUFFIN: Correct.
ALLEN: Yeah. That's nothing. That is - that's insulting. I mean, how stupid do they think the American people are?
MARTIN: OK. That plan does seem to fit with what President Trump has said he wants, though - sending money to people, but not the insurance companies.
SIMMONS-DUFFIN: True. But Republicans would be putting way less taxpayer money into it, about $10 billion into health savings accounts, versus approximately 35 billion towards enhanced subsidies. So it's not just a different delivery system. It's also a big funding cut.
MARTIN: What are you expecting to happen today?
SIMMONS-DUFFIN: Well, there is a super small Republican majority in the Senate, and these bills would need 60 votes to pass. Neither side is likely to reach that threshold, which is not good for people who are navigating open enrollment right now and were hoping for some relief. Polling suggests these enhanced subsidies are quite popular across party lines. So Congress may keep working on this. I do not think that these votes today are going to be the end of the story.
MARTIN: That is NPR's Selena Simmons-Duffin. Selena, thank you.
SIMMONS-DUFFIN: You're welcome. Transcript provided by NPR, Copyright NPR.
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