Vulnerable House Republicans pressured for compromise as shutdown exposes ACA 'pain point'

The bill to end the federal government shutdown did not resolve the core question of extending Affordable Care Act subsidies that are expiring for millions of people, but instead punted it to a vote at a later date with an uncertain path.

However, it has already kicked off a debate among some of the more vulnerable, swing-district House Republicans about a possible bipartisan agreement to keep voter fury off their backs — and according to Punchbowl News, it's already weighing on them heavily.

This comes as House Speaker Mike Johnson (R-LA) has refused to commit to holding a vote on an ACA credits deal at all, even if it does pass the Senate.

"The best option for House Republicans will likely be trying to build momentum around any Senate deal to extend the credits. So it benefits these GOP members to make their ideas known now, as Senate backers hope to craft a bill with a shot of passing the House," reported Laura Weiss, Andrew Desiderio, and John Bresnahan. "It’s worth noting that the House Republicans who back an Obamacare subsidy extension have a lot at stake. Many of them represent swing seats, something Trump and GOP leaders can’t ignore after the Nov. 4 Democratic wipeout. They’re feeling political pressure over rising health care costs. Democrats put a huge spotlight on that pain point with the shutdown fight."

Among the options being discussed to sweeten the deal for Republican moderates are tougher caps on income to receive the extended subsidies, and a minimum premium payment requirement to reduce the likelihood of so-called "phantom enrollments," a fraud scheme where insurance brokers sign low-income, no-cost-eligible people into ACA plans without their knowledge. A GOP think tank purported to find millions of such fraudulent enrollments in a recent study, but experts say that finding might be overstated.

A bigger sticking point, however, is that key Republicans are demanding tougher abortion restrictions in the ACA. Currently, federal law prohibits federal ACA subsidies from going to abortion coverage, but states and private insurers can fund that coverage separately; GOP lawmakers want a prohibition on that as well, which Democrats flatly refuse to entertain.