Happy Thanksgiving week!

Multiple outlets report that the Trump White House is preparing a framework built around a two-year extension of the enhanced Affordable Care Act premium subsidies, which are currently set to expire on 31 December 2025 and would otherwise trigger very sharp premium hikes for roughly 20-plus million enrollees.

The extension would not be “clean”: according to detailed leaks, the plan would pair the extra two years of subsidies with new limits on eligibility and changes in how generous the credits can be. Politico’s reporting, echoed by Reuters, says the White House is looking at imposing an income cap somewhere around 700 % of the federal poverty level for ACA tax credits, significantly below today’s de-facto ceiling, and requiring every enrollee to make at least a small monthly premium payment rather than having a zero-premium plan fully covered by the subsidy.

Behind that topline, the leaks point to a framework that borrows heavily from a bipartisan House bill unveiled late last week. That bill already on the table would extend the enhanced ACA tax credits for two years for households under 600 % of the poverty line, then phase them down above that threshold, while adding a suite of anti-fraud provisions: tighter verification of eligibility, regular checks against federal death records to purge “ghost” enrollees, and stricter policing of brokers. The White House version seems to take that basic structure and add several conservative sweeteners: directing Congress to appropriate funds for ACA cost-sharing reductions that lower deductibles and co-pays; creating an option for enrollees who choose cheaper plans to receive part of their tax credit in a tax-advantaged savings account rather than as an insurer subsidy; and using the minimum-premium rule to answer the long-standing complaint that millions have been signed up into zero-premium plans without much engagement or cost-consciousness.

All of that is well and good.

Or not.

Here's the issue.

Under current rules, the only way Republicans can pass a meaningful bill is through reconciliation.

And the only thing they can do through reconciliation is adjust the financial dials on the currently-existing system that we all agree is broken. They can choose to subsidize some things less, and they can choose to subsidize some things more, but fundamentally, they cannot change the underlying architecture, because of the rules of reconciliation (as interpreted by the parliamentarian, which Senate Republicans have hitherto said they are not going to contradict).

What's more, realistically, they can't even do much of that, since any bill that's going to get 51 Republican votes in the Senate and a majority in the House is going to have to sail between Charybdis and Scylla: between the demands of fiscal conservatives and the realities of the political unpopularity of cutting subsidies.

Therefore, any such bill is going to be a political loser. It's either going to be unpopular by cutting subsidies, or it's going to be unpopular by increasing the deficit, which, since we are no longer in a Zero Interest Rate world, means increasing interest rates and increasing inflation, which are already at voter-angering levels.

There's only one way out.

That's right.

Cut the Gordian Knot.

End the filibuster.

End the filibuster, which Democrats are committed to ending as soon as they regain a majority in the Senate anyway.

End the filibuster, and you can pass a popular healthcare bill, and take away the Democrats' most powerful issue ahead of the midterms.

End the filibuster, and you can pass the deregulation wishlist you've always wished you could pass since Obamacare and before.

End the filibuster, and you can create Large HSAs and high-risk pools to compensate people for the loss of Obamacare subsidies.

End the filibuster, and you can create real antitrust enforcement authority against provider monopolies, and actually cut prices in ways that normal people will notice and in ways that will make this giant sector of the economy healthier.

End the filibuster, and you can tack on all sorts of sweeteners, such as popular coverage mandates (birth! GLP-1s!), more funds for rural health medicine, health AI, and more.

Don't end the filibuster, and you're handing Democrats their best issue to beat you up with from now until next November.

Policy News You Need To Know

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#Science — GLP-1s have acquired a reputation as a miracle drug given their impact on many issues, not just obesity. However, a much-hyped-up study on a potential impact on Alzheimer's failed to show results.