| |  | The Lead Brief | Senate Republicans are having quiet conversations about a longer-term strategy on health policy as the federal government shutdown is about to enter its fourth week. The discussions include provisions that Republican lawmakers had included in the One Big Beautiful Bill earlier this year to provide funding for so-called cost-sharing reduction payments to insurers that would reduce insurance premiums for some lower-income people and save the government billions of dollars. Republican lawmakers on the Senate Health, Education, Labor and Pensions Committee, which has jurisdiction over the policy, met last week to discuss the issue, one Senate Republican health staffer with knowledge of the discussions tells me. The provision around cost-sharing payments was stripped from the legislation by the Senate parliamentarian and determined to be out of order, following objections from Democrats. The National Journal first reported the meeting. A spokesperson for the Senate HELP Committee declined to comment. The GOP health staffer, who was granted anonymity to discuss the private talks, said it might take more education among other Republicans to get the caucus on board because the policy has gotten less ink than the Obamacare premium tax credits. It could be tricky because, although the proposal does lower premiums for some, it likely raises costs for people with more middle-class incomes. The Congressional Budget Office also estimated that the provision could cause roughly 300,000 people to lose coverage. The Republicans’ previous offering in the One Big Beautiful Bill also included a provision that prohibited the cost-sharing payments to plans that covered abortion services, which the Republican aide said would complicate the vote math on any future bill: Including it would alienate Democrats needed to reach the 60-vote threshold in the Senate, and excluding abortion restrictions could jeopardize support from Republicans. → Meanwhile, the Senate Finance Committee oversees the Obamacare tax credits that are under the microscope. Sen. Mike Crapo (R-Idaho) — who leads the finance panel — has said GOP lawmakers are discussing a larger package of health policies to consider at the end of the year and that he’s open to potentially including an extension of the Obamacare tax credits on that vehicle. “I see no reason not to add it,” he told Politico. Some Republicans have been open to an extension of the tax credits — which expire at the end of the year — if the measure includes efforts to combat fraud and income limits on who can receive them. Democrats have remained steadfast in wanting a deal to extend Obamacare tax credits in conjunction with reopening the government, and Republicans say negotiations can’t happen until the shutdown ends — leaving the two sides at an impasse. “I will not negotiate under hostage conditions, nor will I pay a ransom. Period,” Senate Majority Leader John Thune (R-South Dakota) said on Friday. “I am willing to sit down with Democrats to discuss the growing unaffordability and unsustainability of Obamacare,” he said in the social media post. “It’s a system they created, but I’m happy to hear them out. Heck, I’m even willing to give them a vote.” What to watch: In preparation for a larger budget battle at the end of the year, discussions about other health policies — including bipartisan efforts to reform the business practices of pharmacy benefit managers — are also in play. Next week, the Senate HELP Committee is having a hearing on the 340B discount drug program — which Chair Bill Cassidy (R-Louisiana) has said is ripe for reforms. | 
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