On January 8, with 17 Republicans joining all Democrats, the House passed a bill, H.R.1834, that would reinstate the now-expired enhanced Affordable Care Act (ACA) health insurance premium tax credits (PTCs) that were at the heart of the October-November government shutdown. The vote was 230 to 196.

The bill now goes to the Senate, where it is expected to get a vote only if there is a compromise agreement that would modify it to impose an income cap on eligibility for the enhanced PTCs, require a mandatory monthly premium contribution by individuals buying PTC-financed health insurance, establish other anti-fraud procedures, and extend the ACA open enrollment period into March.. A likely two-year compromise agreement, Hill folks say, is "close," but whether to add or exclude additional anti-abortion language remains an unresolved sticking point.

It is also worth noting that even if negotiators reach agreement on an enhanced PTC compromise, it is unclear whether enough lawmakers in either the Senate or the House will vote for it. Currently there is no timeline for "next steps" in the Senate.

That measure was forced on House leadership by a discharge petition that passed the House just before it recessed for the holidays last month. Insiders now believe that House passage of the three-year enhanced PTC measure will trigger movement in the ongoing talks about modifications to the now-expired PTC enhancements and result in a compromise that could reverse, or at least mitigate, the dramatic (100 percent or more, on average) ACA health insurance premium increases that are now in effect.

Talks on a compromise continued during the holiday break and remain ongoing. However, no agreement has yet been reached. But it appears that a bipartisan group of Senators is looking at a reinstatement of the PTC enhancements for two years, with a new eligibility requirement (an income cap of 700 percent of the federal poverty level), a mandatory $5/month (or $60/year) premium contribution requirement, stricter reporting requirements, extension of the ACA open enrollment period into March, and possibly a ban on the use of health insurance financed in any part by the PTCs for abortion services. The abortion question is hugely controversial, though, and insiders think it could cause compromise talks to break down altogether.

Lawmakers are deeply divided on this issue. Conservatives representing very conservative districts and states do not want any extension of the enhancements to the PTCs. Progressives, bolstered by their liberal constituencies, want the three-year extension without modifications. Those in the middle have differing red lines, and thus different positions on the contours of a package of modifications which they would support. But all lawmakers are concerned about the impact of the expiration of the enhancements to the PTCs, both on individuals impacted by the resulting health insurance premium increases and on the political impact of the expiration when voters are making up their minds about who to support in the November mid-term elections.

Prospects: What the Senate will do in response to the House’s approval of HR 1834 is still murky—it all depends on whether negotiators (which include the Administration as well as House members along with Republican and Democratic Senators) can craft a compromise that will win enough support to win enactment in both chambers of Congress.

The bottom line is that this issue has taken center stage (along with government funding) this month. But what the ultimate resolution of it will be remains uncertain. We will keep you posted.

NAIFA Staff Contacts: Jayne Fitzgerald – Director – Government Relations, at jfitzgerald@naifa.org or Mike Hedge – Senior Director – Government Relations, at mhedge@naifa.org.