Republicans are broadening the range of possible approaches to respond to the expiration of enhanced Affordable Care Act (ACA) premium tax credits — not narrowing them — and GOP leaders are positioned to oppose a straight extension, leaving a quick resolution to the issue increasingly uncertain. The enhanced credits expire at the end of 2025, and Senate Majority Leader John Thune (R-SD) has said he is "committed to having that vote no later than the second week in December." Extending the ACA enhanced tax credits faces an uphill battle in both the Senate and the House, with some Republican lawmakers and the White House exploring alternative health care proposals. GOP members are split over whether to let the enhanced subsidies expire, back an extension with new limitations, or support a broader health care reform package.

During a November 18 news conference, House Majority Leader Steve Scalise (R-LA) said the three committees that work on health care policy — Ways and Means, Energy and Commerce, and Education and the Workforce — have been working on legislation "that would actually lower costs for families and give families options so they're not trapped in the 'Unaffordable Care Act' policies that drive up their premiums." He alluded to provisions that "didn't make it all way through the process" of enactment of the "One Big Beautiful Bill Act" (OBBBA) and said, "We're going to be coming back to that."

Politico reported that a November 18 House Republican Conference meeting reportedly aired differences of opinion among leaders and rank-and-file members, with Rep. Nathaniel Moran (R-TX), a Ways and Means member, challenging leaders on why they were attacking the ACA credits now — with their expiration imminent — instead of discussing alternatives months ago. Another report said that Ways and Means Committee Chairman Jason Smith (R-MO) supports reviving health savings account (HSA) provisions dropped from the OBBBA.

Others in Congress and the White House support using the budget reconciliation process, which requires only a 51-vote majority in the Senate, to enact a Republican-only health care bill, although many of the conservative health care priorities left out of OBBBA would not be feasible for reconciliation due to the Byrd rule. White House Deputy Chief of Staff James Blair, at the Bloomberg Government policy breakfast on November 18, said, "We're going to have the health care conversation. We're going to put some legislation forward." While he was open to a bipartisan health plan, he said, "if that path is foreclosed, there is the partisan path of reconciliation as well."

Meanwhile, Senate HELP Committee Chairman Bill Cassidy (R-LA) on November 17 detailed his approach to the credits. "Cassidy's proposal would allow people who signed up for a so-called Bronze Plan through Obamacare marketplaces to get a prepaid HSA, funded in part by the lapsed tax credits," CNBC reported. "While HSAs would not help pay for monthly premiums, Cassidy told reporters that they would help reduce the cost of health-care expenses, such as co-payments, deductibles, and coinsurance." However, Senator Jeanne Shaheen (D-NH) has said she doubted that significant reforms of the type that Senator Cassidy is proposing could be enacted in the timeframe available to lawmakers.

A November 18 Semafor report said that assessing the direction of the issue, in the Senate at least, requires a determination by senators in both parties and the President of "whether there will be a real bipartisan negotiation over health insurance premiums — or merely a political vote that is litigated in the midterms." The report cited Senator Shelley Moore Capito (R-WV) as saying a clean extension of the tax credits "would get voted down" by Republicans but adding that "there could be a negotiated product. I think there's a real possibility for that, especially if the president weighs in on this."

President Trump did weigh in on social media late November 18, saying in part: "THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE … "

Trade — The latest edition of the WCEY newsletter "Trade Lines" is available here.

Elections — The Texas Republican redistricting plan — the prime mover of a multistate effort initially encouraged by President Trump then pursued by Democratic states in response — on Tuesday was blocked by a federal court as unconstitutional. The plan could net five additional Republican seats in next year's midterm elections. Texas is now appealing to the Supreme Court. In response to the original Texas proposal, California Democrats put forward a redistricting plan that could add as many as five Democratic seats and was approved by voters in the off-year elections November 4. CNN noted that the California plan initially included a trigger for it to take effect only if the Texas effort was successful, but the final version did not.

The Texas redistricting plan also has implications for the Ways and Means Committee, as Rep. Lloyd Doggett (D-TX) is planning to retire if it is successfully implemented. Rep. Doggett said November 18: "To borrow from Mark Twain, the reports of my death, politically, are greatly exaggerated. A U.S. district court order means that I have a renewed opportunity to continue serving the only town I have ever called home, as democracy faces greater challenges than at any point in my lifetime. While this decision, led by a Trump-appointed judge, will be appealed, I am hopeful about the final outcome … "

The Wall Street Journal reported of the redistricting landscape generally: "New maps favoring the GOP more heavily have also passed in North Carolina and Missouri, while an effort to redraw in favor of Democrats is moving forward in Virginia. A bipartisan redistricting commission approved a map that could help Republicans pick up a seat or two in Ohio, while, in Utah, a new court-ordered map will allow Democrats to pick up a seat."

Former Rep. Ben McAdams (D-UT) has announced that he is running in Utah for a newly drawn Democratic-leaning district. "The seat was created amid a national redistricting fight after a state judge this month rejected a congressional map drawn by Republicans and adopted an alternate proposal," the Washington Post reported. "Utah has not had a Democratic member of Congress since 2021, after McAdams lost his seat — which at the time represented a conservative district … "

Budget — The House Budget Committee held a November 18 hearing on "Oversight of the Congressional Budget Office" with CBO Director Phillip Swagel, after Republicans questioned some of the estimates produced by CBO during consideration of the OBBBA and following a cybersecurity issue at CBO. Chairman Jodey Arrington (R-TX) suggested an independent audit of the CBO's work, modeling, transparency, etc. Swagel responded, "I support that. I support having people look at what we're doing [and] give us constructive feedback."

It was the first hearing since Chairman Arrington announced he would not run for re-election next year. Ranking Member Brendan Boyle (D-PA) praised the chairman's handling of the Committee, saying, "Three years ago when you sat down for your first hearing as chair, and my first hearing as ranking member, we both independently said that this would be a committee about serious policy work … and under your leadership the last three years — and I hope I've helped on this — we've stuck to that." Chairman Arrington said, "I am proud of the culture of serious policymaking, serious consideration of the fiscal trajectory and decline and the sincerity of every member in their approach to address that."

Schedule — The Senate Finance Committee is holding a hearing today (November 19) at 10 a.m., "The Rising Cost of Health Care: Considering Meaningful Solutions for all Americans."

Prior to the hearing, the Committee will hold an executive session to vote on the nominations of:

• Arjun Mody to be Deputy Commissioner at the Social Security Administration
• Jeffrey Goettman to be a Deputy United States Trade Representative (Africa, Western Hemisphere, Europe, the Middle East, Environment, Labor, and Industrial Competitiveness)
• Julie Callahan to be Chief Agricultural Negotiator, Office of the United States Trade Representative
• Thomas Bell to be Inspector General, Department of Health and Human Services

The House Ways and Means Health Subcommittee is holding a hearing today (November 19) at 2 p.m., "Modernizing Care Coordination to Prevent and Treat Chronic Disease."