Georgia Republicans Caught In A Bind Of Trump's Making Over Health Care Costs

Republicans across the country are in a bind of President Donald Trump’s making: After voting to end the 43-day federal shutdown, they have yet to articulate a plan to tackle the upcoming spike in health care premiums.

That conundrum is coming into sharp relief in Georgia, a state with an especially high reliance on the Affordable Care Act, where Republicans have one of their best opportunities to pick up a Senate seat as they fight to maintain their grip on Congress.

Georgia Republicans running to unseat Democratic Sen. Jon Ossoff are avoiding talking about health care in their crowded primary, giving him leverage to tout his vote against the shutdown on the grounds that the deal did not address the loss of subsidies. One study from the Georgia Health Initiative projected premiums will more than double, on average, after the planned Dec. 31 expiration of the subsidies.

As the Republican leadership trifecta in Washington scrambles to address that imminent spike in premiums for millions of Americans, health care costs are emerging as a new flashpoint in next year’s midterm elections. Polling shows staunch nationwide support for the Affordable Care Act, with 64 percent of Americans holding a positive view of the policy, according to a September survey conducted by the health policy organization KFF. That includes two-thirds support among independent voters, who will be crucial for either party's success next year. And in Georgia, where nearly 15 percent of the population is enrolled in marketplace health insurance, Republicans stand to bear the brunt of voters’ ire if their party fails to offset those looming price hikes.

“This is how I see it: Republicans are right on the policy and in a bind on the politics,” said Brian Robinson, a Republican strategist who served as a senior aide to former Gov. Nathan Deal. “They’re right in the policy in the sense that (the Affordable Care Act) is unaffordable in the long term. We do have to find the fix, and the fix is going to have some downside.”

None of the three Republican hopefuls running in what will be one of the most competitive Senate races in the country next year have meaningfully addressed how to mitigate the jolt in costs. Like most Republicans, the two Georgia candidates holding House seats — Mike Collins and Buddy Carter — voted to end the shutdown without addressing the looming expiration in subsidies.

And the third candidate, former football coach Derek Dooley, has yet to take a position on how he would approach legislating a solution.

In written statements, all three derided what they described as a broken health care system while declining to address how they would fix the immediate rise in costs.

“As the husband of a doctor, Derek knows firsthand how broken the healthcare system in this country is. This problem requires a serious debate, and then real solutions that lower costs and put patients — not insurance companies or the status quo — first,” read the statement from Dooley spokesperson Connor Whitney.

“Since the passing of the Unaffordable Care Act, premiums have risen over 80% while the insurance companies we subsidize boast record profits. The only party winning is the insurance industry,” Collins wrote in his own statement. “We need an overhaul of the healthcare system that gives Americans more options, drives down rising premiums, and is more accessible.”

Carter took a similar tack: “Democrats broke health care with Obamacare. Since then, they’ve had no choice but to subsidize it, which proves that it’s not working,” he wrote in a statement. "Jon Ossoff wants to keep throwing good money after bad and ensure that illegal immigrants benefit. We need to fix health care, and it starts by undoing the rot that the Democrats brought on when they got big government involved in our health care system.”

Collins and Carter are in a wait-and-see position as Capitol Hill leaders work to hammer out a compromise on health care.

Over 1.5 million Georgians rely on the state-based exchange known as Georgia Access for insurance, making the Peach State host to the fourth-highest marketplace enrollment in the country, according to one analysis. Over 90 percent of those enrollees use the federal subsidies to afford their insurance.

“You can really see the impact of the enhanced premium tax credits on the marketplace and having that increased affordability really pushed our marketplace enrollment quite high,” said Laura Colbert, executive director of the advocacy group Georgians for a Healthy Future.

But when the subsidies expire at the end of the year, 340,000 of those enrolled are projected to lose their insurance as premium prices skyrocket, per the Georgia Health Initiative projection.

That will likely foment before the end of the year, Colbert posited, describing Dec. 15 as a “drop dead” date by which insurance companies will start delivering premium notices to auto-enrolled customers about their 2026 coverage.

“Rural Georgians are going to feel this in a bigger way than those of us who live in the metro Atlanta area,” she added, saying “folks that live in rural areas tend to be older and so therefore premiums are already a lot higher in those regions.”

Ossoff seems to recognize the political upper hand Democrats have in this fight.

He declined to join the eight breakaway members of the Democratic caucus earlier this month to reopen the federal government. Instead, he held the party line and voted against the deal that omitted an extension for the subsidies – an acknowledgement of the issue’s potential potency for Democrats next year.

“Premiums are set to double for 1.4 million Georgians and nearly half a million Georgians could lose health insurance altogether,” Ossoff said in a statement after casting his vote. “With health care votes ahead, the question is whether Republicans in Congress will join us to prevent catastrophic increases in health insurance premiums.”

Those rural parts of the state are key to Republicans’ electoral strategies, especially in Georgia, where GOP candidates vie for votes to offset the sapphire-blue returns from Atlanta and surrounding suburbs.

“This issue is not one that will dominate a primary,” Robinson said. “Because health care doesn’t dominate Republican primaries. It’s just not what the voters are going to go and vote on. And the ones who do aren’t going to be anywhere near a majority.”

The general election will likely present a different dynamic. Democrats feel strong after recently flipping two seats on Georgia’s Public Service Commission, which regulates the state’s energy rates, marking their first non-federal statewide wins in decades.

“Affordability remains the top issue,” Robinson said. “I’m not an expert on what’s going to be coming into people’s inboxes as far as premium increases in January, but if there is a shock factor and it is a large number of people, that’s cause for concern.”

“I think Republicans need to figure out how to message this if there’s not going to be a course correction or change in policy,” he added.

Trump is expected to soon roll out a policy framework that includes a two-year extension of Obamacare subsidies, POLITICO and MS Now reported Sunday night.

Despite Trump’s earlier insistence that the only health care measures he would support would have to include sending money “directly back to the people,” health care talks among Republican leaders on Capitol Hill already seem to have lost steam for finding a solution before year's end.

That solution won’t be coming from state leaders either.

“Gov. Kemp has been pretty clear: we’re not going to clean up any mess produced by Washington, D.C.,” Sen. Ben Watson, Republican chair of the state Senate’s Health and Human Services Committee, said. “We’re not here to make up any shortfalls that the congressional maneuvers or compromises will create.”

Carter Chapman, a spokesperson for Georgia Gov. Brian Kemp, agreed with that sentiment, adding in a statement that the subsidies’ future is “a matter for Congress to decide.”

Even if the debate over health care has yet to thoroughly play out in the Republican primary, Robinson cautioned that Republicans should keep their eye on the ball: “A marginal issue can be a decisive issue.”