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Congress searches for a path to renew expired Affordable Care Act subsidies

MARY LOUISE KELLY, HOST:

Seventeen House Republicans joined with Democrats to pass a measure that would extend health insurance subsidies that lapsed at the end of last year. But that three-year extension is unlikely to pass the Senate where a similar measure failed in December. We do know, though, a bipartisan group of senators say they are nearing a compromise to resurrect the subsidies. Here to help us sort through all of that, NPR congressional reporter Sam Gringlas, who's tracking it from Capitol Hill. Hey, Sam.

SAM GRINGLAS, BYLINE: Hey, Mary Louise.

KELLY: OK. So there are a lot of moving parts here. Let's start with a central player, the speaker of the House, Mike Johnson, who we know opposes these subsidies, vehemently opposes them. He has the ability to control what gets a vote in the House. How did this measure even get to the floor?

GRINGLAS: Yeah. So for weeks, the speaker refused to hold a vote on the subsidies, despite more than a dozen members of his caucus pressing him to. So four Republicans joined with Democrats to force a vote using a maneuver called a discharge petition, that, until recently, has been used relatively sparingly.

KELLY: OK. So these four Republicans, they force a vote. We know that even more are backing the legislation. This seems like a blow to Speaker Johnson, no?

GRINGLAS: Well, he would not describe it that way. Johnson has told reporters that this is just the reality of having a paper-thin majority. But the speaker has now been circumvented several times during this Congress. It was also a discharge petition that forced the vote to release the Epstein files. Democrats are heralding this subsidies vote as a vindication of their strategy to withhold votes from funding the government for weeks last fall. And though that shutdown ultimately ended without a deal to extend the subsidies, Democrats say their tactics elevated the issue and paved the way for this vote today.

KELLY: Let's tiptoe across the Capitol to the Senate, which, as we mentioned, has already rejected a three-year extension. So what happens when this House legislation leaves the House and goes to the Senate?

GRINGLAS: Well, this legislation, as it is now, is basically dead on arrival over there, but its boosters have said a strong showing in the House would recharge negotiations in the Senate, and that seems to be happening. A bipartisan group of senators has been working on compromise legislation this week, and this morning, several of them met with a group of House members, including Republican Congressman Brian Fitzpatrick of Pennsylvania. He was the first Republican to sign that discharge petition.

BRIAN FITZPATRICK: The senators made it abundantly clear that but for this action in the House, which we had to take the discharge route, unfortunately, that that was incredibly important for them to breathe life back into this issue and really force the Senate to take this up, which I believe they will.

KELLY: Sam, as you know better than I, it's so rare these days to use those four groups - those four words in a row, a bipartisan group of senators. So tell me more about these bipartisan talks.

GRINGLAS: So Congressman Fitzpatrick described the meeting this morning as a packed house with an almost equal number of Democrats and Republicans. Several members involved in these negotiations have told reporters a deal is close. One potential sticking point, though, is that some Republicans want more stringent language around ensuring federal money is not used for abortion. President Trump earlier this week said Republicans may need to be a little flexible on this, and we've gotten, you know, conflicting readouts on how much of a problem this going to pose.

KELLY: And what do we know about what might be in this potential compromise legislation?

GRINGLAS: Senators involved in the talks say the emerging deal would be a two-year extension. In the second year, patients could choose to have funds deposited in a health savings account, something Trump has been pressing for, and open enrollment would likely be extended, as well.

KELLY: And just briefly, how likely is it these subsidies will get resurrected in the end?

GRINGLAS: It is not clear, though Congressman Fitzpatrick told reporters today that if a deal does advance from the Senate, it will come back for a vote on the House floor one way or another.

KELLY: NPR's Sam Gringlas, thank you.

GRINGLAS: Thank you. Transcript provided by NPR, Copyright NPR.

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Sam Gringlas
Sam Gringlas is a journalist at NPR's All Things Considered. In 2020, he helped cover the presidential election with NPR's Washington Desk and has also reported for NPR's business desk covering the workforce. He's produced and reported with NPR from across the country, as well as China and Mexico, covering topics like politics, trade, the environment, immigration and breaking news. He started as an intern at All Things Considered after graduating with a public policy degree from the University of Michigan, where he was the managing news editor at The Michigan Daily. He's a native Michigander.