Why Republicans can't agree on health care legislation

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By David M. Drucker / Bloomberg Opinion

Lost amid the political implications of allowing certain Obamacare subsidies to expire is the fact that this is Year 17, and counting, of Republicans failing to agree among themselves on health care policy.

The political implications matter, of course. That phrasing — “political implications” — is clinical, Washington-speak for roughly 22 million Americans being on the verge of losing an additional layer of federal assistance first made available during the coronavirus pandemic, without which their health insurance premiums will skyrocket. Some significant percentage of these people, who purchase policies on the Affordable Care Act exchanges, won’t have the cash to cover the higher cost and will be forced into less generous coverage or none at all. Republicans are not indifferent to the impact this will have on voters and their families, nor clueless about the backlash it might precipitate in the 2026 midterm elections.

But Republicans in the House of Representatives and the U.S. Senate are paralyzed by internal divisions over what to do about health care, and that has a lot to do with why Congress recessed for the holidays without approving legislation to address the insurance cliff created by the expiration of these “enhanced” pandemic-era subsidies.

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“The reason why Republicans can’t coalesce around a proposal is because it’s hard; it’s really hard. This is a difficult issue,” Charlie Dent, a Republican former congressman from Pennsylvania, told me, explaining that health care reform is complicated, politically risky and generally requires writing new government regulations and appropriating fresh sums of taxpayer dollars. None of that, especially the latter two, is especially appealing to Republicans on Capitol Hill (nor has it been particularly appealing to President Donald Trump during his first and now second stint in the White House).

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