特朗普和众议院共和党就奥巴马医改补贴问题可能发生冲突。
Trump And House GOP Are Headed For A Clash Over Obamacare Subsidies

原始链接: https://www.zerohedge.com/political/trump-and-house-gop-are-headed-clash-over-obamacare-subsidies

## 奥巴马医改补贴之争升温 一项迫在眉睫的期限威胁着超过2000万美国人的医疗成本,因为增强的《平价医疗法案》(ACA)补贴将在年底到期。这场斗争不仅仅是党派之间的对抗,而是共和党*内部*的冲突。特朗普暗示可能需要暂时延长以进行进一步谈判,但众议院议长迈克·约翰逊坚决反对继续补贴,认为这等于资助一个“破败的系统”,而没有解决成本上升的问题。 白宫提议延长两年,并加强资格审查和欺诈预防,但面临共和党的抵制。一个两党小组提出了“HOPE法案”,同样延长补贴两年,并设置收入上限,旨在为更长期的解决方案搭建“桥梁”。 然而,这些提议并未解决那些不符合补贴资格的人,他们仍将面临保费上涨。民主党人认为这是一个政治优势,他们团结一致地希望延长补贴,并利用共和党内部的分裂。由于目前的资金决议将在一月份到期,僵局似乎不可避免,可能导致许多美国人的保费大幅上涨。

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原文

Obamacare subsidies expire at the end of December, and it now looks like the big battle over their future won’t be between Democrats and the GOP, but between the White House and House Republicans.

Trump has said that while he doesn’t want to make the subsidies permanent, that "some kind of an extension may be necessary to get something else done because the unaffordable care act has been a disaster. It's a disaster."

The White House proposal caps eligibility at 700% of the federal poverty line and kills off zero-premium plans that have become a magnet for fraud. But House Speaker Mike Johnson has made it clear this idea hits a wall with the GOP. Even with these anti-fraud provisions attached, Trump's plan still pours billions into the same broken system, and does nothing to address the key problem created by Obamacare: the skyrocketing costs of subsidies.

The obvious problem here going into midterms is optics... with millions of Americans - including a ton of lower income red state residents, forced to suddenly come up with potentially thousands of dollars more per month after already adjusting to the inflationary 'new normal' thanks to the egregious overreaction to the economy-killing pandemic shutdown that never should have happened in the first place.

According to the Wall Street Journal, Johnson “cautioned the White House that most House Republicans don’t have an appetite for extending enhanced Affordable Care Act subsidies, according to people familiar with the matter, showing how hard it will be politically to stave off sharp increases in healthcare costs next year for many Americans.”

The message from Johnson, in a phone call with administration officials, came as President Trump’s advisers were drafting a healthcare plan that extended the subsidies for two years.

The warning underscores the hurdles facing any deal in coming weeks. Lawmakers have a mid-December deadline for healthcare votes promised as a condition for Democrats voting to end the government shutdown earlier this month. The enhanced subsidies expire at the end of the year, affecting more than 20 million people who benefit from the tax credits. 

While the White House and GOP leadership circle each other, a bipartisan group of lawmakers has worked out a separate solution. However, their proposal still relies on extending the subsidies.

The Bipartisan Healthcare Optimization Protection Extension (HOPE) Act extends the enhanced premium tax credit for two years. It includes a lower income cap for enrollees, about $200,000 for a family of four, and phases out for those making above that (currently the subsidy is capped based on what percent of a family’s income it spends on health care). The bill would also try to crack down on fraud.

We don't want to see premiums skyrocket, but we probably need a deeper plan for the longer term to deal with the high cost of healthcare,” said Rep. Don Bacon (R-Nebr.). “What we're proposing is a bridge. Let's help keep people's premiums down — that's important — and it’ll give us time to work on it, maybe something better over the next year or two.”

People are freaking out. I mean, I get phone calls from people about seeing their premiums go up by a thousand dollars a month,” Rep. Tom Suozzi, a New York Democrat, said. “That's why we felt it was very important for us to get together as a bipartisan team to say, let's work together and let's force something to happen here that we can try and build consensus on.”

These solutions don’t solve the problem for millions who never qualified for subsidies, who will see their premiums soar regardless. Extending subsidies deepens the distortion and accelerates the problem. 

The subsidy fight puts Republicans in a tough spot. Johnson has already shown he will not bless another round of Obamacare cash, and most of the conference stands with him. Trump’s team is floating the idea of a temporary extension, and that puts the party on a collision course as January approaches. The CR runs out at the end of January, and nothing suggests the White House and House Republicans will bridge this gap before then.

Meanwhile, Democrats see an easy opening. They are unified, they want this fight, and they know the GOP’s internal split hands them the leverage they lacked during the last shutdown. Washington is drifting toward another stalemate, and the setup looks far worse for Republicans this time around. The stage is set for a January showdown that could break wide open once the subsidies expire.

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