The Senate is poised to vote on Thursday on two separate plans aimed at addressing a spike in health care costs that are expected for tens of millions of Americans who receive enhanced Affordable Care Act tax credits unless Congress acts.

Both plans, one put forward by Democrats and the other championed by Republicans, are almost certain to fail.

After they do, lawmakers will have only a matter of days remaining to address the expiration of the enhanced tax credits, and there’s little indication that any sort of breakthrough is on the horizon. 

Democratic plan: 3-year extension of expiring enhanced tax credits

The Democratic plan that will receive a vote on Thursday proposes a three-year extension of the enhanced Affordable Care Act subsidies that are otherwise set to expire on Jan. 1. The enhanced subsidies were originally put in place during the COVID-19 pandemic.

During remarks on the floor Wednesday, Minority Leader Chuck Schumer called the Democratic plan the “only realistic path left” to address the looming premium spike. 

“We have 21 days until Jan. 1. After that, people’s health care bills will start going through the roof. Double, triple, even more,” Schumer said. “There is only one way to avoid all of this. The only realistic path left is what Democrats are proposing — a clean direct extension of this urgent tax credit.”

Even though Democrats are in the minority, they are getting a vote on their proposal, as part of a deal struck by a small group of Senate moderates to re-open the federal government after a 43-day shutdown, which centered around Democrats’ efforts to address the expiring tax credits.

“What we need to do is prevent premiums from skyrocketing and only our bill does it is the last train out of the station,” Schumer said. 

But any health care proposal in the Senate will require 60 votes to pass, which means members of both parties would need to lend votes to approve a plan. 

Majority Leader John Thune made clear Wednesday that Republicans will not support the Democratic plan. 

Thune called the Democratic proposal a “partisan messaging exercise” and said that Democrats’ claim that their plan would lower health care costs represented a “tour of fantasy land.”

Republicans have for months been saying that the premium subsidies require reform. Without changes, Republicans say, the enhanced subsidies create opportunities for waste, fraud and abuse and have driven up the overall cost of premiums.

The nonpartisan Congressional Budget Office estimates that the Senate Democrats’ proposal would add nearly $83 billion to the federal deficit over the next decade. CBO also estimates that enacting the Democrats’ legislation would increase the number of people with health insurance by 8.5 million people by 2029.

Pointing to the cost of extending the subsidies, Thune said, Democrats ought to put forward a program that makes modifications to the program. 

“That’s not what they did … No changes,” Thune said. “Just continue to run up the cost. Run up the cost in the individual marketplace like that — but have the American taxpayers pay for it and then go tell people that you’re trying to keep their premiums down,” Thune said. “This does nothing, nothing, to lower the cost of health insurance.” 

Republican plan: Do away with the enhanced tax credits and create HSAs

Republicans will offer an “alternative” plan on the Senate floor on Thursday.

The Republican proposal, championed by Senate Health Committee Chairman Bill Cassidy and Senate Finance Committee Chairman Mike Crapo, would do away with the enhanced tax credits and instead take the extra money from those tax credits and put it into health savings accounts for those who purchase bronze-level or “catastrophic” plans on the ACA exchanges. Republicans say this will help Americans pay for out-of-pocket costs.

Under the plan, individuals earning less than 700% of the federal poverty level would receive $1,000 in HSA funding for those between age 18 and 49 and $1,500 for those age 50-64. Republicans say these funds could be used to help cover the higher deductibles on lower cost plans. 

Republicans say that their plan will reduce premiums through cost-sharing reductions and tout that the plan stops payments to insurance companies. Thune called it a “very different business model” than what Democrats are proposing. 

“The question is do you want the government deciding this, ordo you want to put this power and these resources in the hands of the American people?” Thune said on the Senate floor on Wednesday. “American taxpayers. Patients. That’ what we’re about.“

This bill is also unlikely to pass the Senate on Thursday. Schumer called it “dead on arrival”.

“I want to be very clear about what this Republican bill represents, junk insurance,” Schumer said. “Let me tell my Republican colleagues: it is dead on arrival. The proposal does nothing to bring down sky-high premiums; it doesn’t extend the ACA premiums by a single day. Instead, Republicans want to send people $80 dollars and pretend that is going to fix everything.” Schumer said. 

Cassidy this morning called Schumer’s categorization of his plan as a “junk plan” “so ironic.”

“These are Obamacare plans. These are the plans they put in place, except that when they did the plans, they’ve got $6,000 deductibles, or $7,500 deductibles. We addressed that deductible. We make these plans better,” Cassidy said. “We Republicans are trying to make it better. We want money in your pocket for your out-of-pocket [costs], and they want you to front the whole thing.”

Democrats also take umbrage with provisions in the GOP bill that prevent funds from being used for abortions. Schumer, on the Senate floor, called it a “poison pill.”

Sen. Patty Murray, the top Democrat on the Senate appropriations committee, was asked if she saw any way that Democrats could support the bill today.

“Not with the choice issues in it, where they have made it that women cannot get access to an abortion through their plan,” Murray said. “I don’t see any way that this helps the people that are being hurt right now by the tax credits going away.”