Republicans risk moderates, US House majority, with no healthcare extension

By David Morgan

WASHINGTON, Dec 19 (Reuters) – Republican worries about losing their majority in the U.S. House of Representatives next year erupted this week, when four moderates joined Democrats in a last-ditch effort to prevent a spike in healthcare costs for 24 million Americans beginning in less than two weeks.

The four – Representatives Rob Bresnahan, Brian Fitzpatrick and Ryan Mackenzie of Pennsylvania and Mike Lawler of New York – are part of a larger group of about a dozen House Republicans who had been pushing for their own bipartisan reforms aimed at protecting constituents in swing districts by extending healthcare subsidies due to expire after December 31 under the Affordable Care Act, also known as Obamacare.

They represent a small but crucial slice of the House — members who represent the roughly three-dozen of the 435 seats that are expected to be competitive in November’s midterm elections — which will determine whether President Donald Trump’s Republicans hold their majority or Democrats seize it. 

But they were unable to reach agreement with Republican leaders, who sought  conservative restrictions that lawmakers found unpalatable. 

“We wanted an up or down vote,” said Lawler, who faces a toss-up election in his district just north of New York City.  “Unfortunately, leadership found every way not to let that happen. And so, we were left with no choice but to sign the clean three-year (Democratic) extension and force a vote.”

Republicans are already facing election headwinds, given Trump’s slumping approval ratings, public discontent over rising prices and a political cycle that often punishes the party of the sitting president, according to independent analysts.

Trump’s party is pushing hard to overcome that historic pattern, including by launching a campaign to redraw congressional districts in Republican-controlled states in their favor, a move that Democrats are scrambling to counter.

SUBSIDIES EXPIRING

Moderate House Republicans, critical to Republican control on Capitol Hill, face heightened risks with Congress unable to extend the healthcare subsidies and cut short a dramatic rise in private health insurance premiums for Affordable Care Act beneficiaries beginning on January 1.

“In the event of a Blue wave next year, the members in the competitive seats are the ones who are going to pay the price, even if they’re the ones who want to restore these Obamacare subsidies,” said Kyle Kondik, a political analyst at the University of Virginia Center for Politics. 

“They want to at least be able to go on record and say, ‘Hey, I voted to extend these subsidies’,” Kondik added.

The bill from House Democratic leader Hakeem Jeffries that moderates signed onto has already failed in the Senate.

Moderates hope House approval will spur a bipartisan compromise that can pass both chambers, which analysts say would help people facing skyrocketing health insurance premiums. But there is no guarantee of agreement on an issue that has eluded lawmakers for months, and healthcare costs will begin rising before the vote can be held.

HOUSE PASSES PARTISAN BILL

The House instead passed a partisan healthcare bill that aims to lower premiums for some people while reducing overall subsidies and raising premiums for others, starting January 2027, two months after the November election.

House Speaker Mike Johnson, who maintains that he worked to get moderates a vote on their legislation, denied that they could be more vulnerable to Democrats in the midterms after the ACA subsidies expire. 

“These are extraordinary people. They know how to run campaigns, and they’re going to have a great record to run on,” Johnson told Reuters, adding that Republicans would vote on more legislation next year aimed at lowering healthcare costs.

Republican moderates have been unwilling to talk about their drive to extend ACA subsidies in terms of their own reelection prospects.

“We have a healthcare problem we have to fix. That’s all I care about. The politics will take care of themselves,” said Fitzpatrick, whose Pennsylvania district was won by Democrat Kamala Harris in the 2024 presidential election, according to the Ballotpedia website.

Democrats, who view rising healthcare costs as the centerpiece of a powerful campaign issue on affordability, hope to take full advantage of the Republican-controlled Congress’ inaction on ACA subsidies, potentially repeating their victory in 2018 when they used Republican efforts to repeal Obamacare as an issue to capture the House.

Trump appeared to cement the fate of ACA subsidies on Wednesday, by backing a Republican proposal to send cash directly to the public to offset the cost of health insurance, rather than to insurance companies, in a rare evening address. 

‘MORE POTENT ISSUE’ THAN IN 2018 MIDTERMS

Democrats will try to blame Republicans for cuts to Medicaid under Trump’s tax cut and spending bill as well as spiraling health insurance costs that result from the loss of ACA subsidies. 

“Between the Medicaid changes and the impending premium spikes, I think that’s a more potent issue than was the case in 2018,” said Charlie Dent, a former Republican congressman who now heads the Aspen Institute’s congressional program.

With a current House majority of 220-213, Republicans can afford to lose no more than three seats and still retain control of the chamber. But they face more than a dozen toss-up races and still more contests where Democrats could be in a position to score upset victories.

Democratic incumbents are also facing toss-up elections and other races where Republicans are likely to be competitive.

But analysts say Democrats currently hold the upper hand, barring any breakthrough in Trump’s campaign to eliminate Democratic seats through mid-decade redistricting.

Meanwhile, Democrats say they have no doubts about their chances next November. 

“They’re going to lose the House. Hakeem Jeffries will be speaker,” said Democratic Representative Nancy Pelosi, who was elected to a rare second term as speaker after Democrats took control of the chamber in 2018.

“There is no question about that, and it will be because of healthcare. Well, healthcare and affordability and corruption,” she told Reuters.

(Reporting by David Morgan; editing by Scott Malone and Alistair Bell)