For all the taxes Congress is aiming to cut, one has surprisingly dodged the ax so far: the $14.3 billion “Health Insurance Tax,” or HIT.

It would seem like a ripe target, especially for Republicans. It was imposed as part of President Obama’s Affordable Care Act. It directly adds to the high cost of health insurance. It falls particularly hard on small businesses and individuals shopping for non-group coverage, who already face steep premium spikes. And lawmakers previously voted to suspend it for 2017.

Yet efforts to repeal the tax – or at least continue the suspension for 2018 – keep hitting obstacles in Washington.

First, the GOP’s plans to repeal and replace the Affordable Care Act—which would have abolished the HIT along with other ACA-related taxes—died in the Senate. Then, the HIT was omitted from the separate tax-cut plans passed by the House and Senate, which appear to be headed for approval this month.

Most recently, insurance industry lobbyists have sought to include HIT suspension in budget legislation that Congress must pass before the end of the year to keep government operating. Yet that, too, is running into resistance in the House, where officials are reportedly saying it’s too late for an across-the-board suspension in 2018.

As reported Thursday by Politico:

House Republican tax writers are considering delaying Obamacare’s health insurance tax for only limited markets next year, leaving out small businesses and possibly private Medicaid plans, according to sources on and off Capitol Hill. They would suspend it for all markets in 2019.

Republicans on the Ways and Means Committee are worried that it will be difficult for the small businesses to send prospective savings from delaying the tax back to consumers. Industry sources, however, say it is possible.

Insurance taxes are tempting for lawmakers because they are hidden from the public and directly affect a constituency—the insurance industry—that is a favorite scapegoat of both parties. This helps to explain how insurance surcharges levied under New York’s 20-year-old Health Care Reform Act have risen to become the state’s third-largest tax, bringing in more than $4 billion a year.

Ultimately, though, it’s consumers who pay the tab for insurance taxes, in the form of higher premiums.

On average, the return of the HIT would add about 2.6 percent to premiums, according to a study commissioned by the UnitedHealth Group. That equates to an extra $158 to $188 for individual coverage, $500 to $535 for family coverage, $245 for Medicare Advantage plans, and $181 for Medicaid managed care plans.

The total cost for New Yorkers in 2018 would be $1.1 billion, the study estimated.

Some consumers are hit harder than others: Large employers who self-insure do not pay the HIT, and are therefore unaffected. Lower-income individuals buying coverage through Obamacare exchanges would be insulated from any impact, because federal tax credits would offset the cost.

Most exposed to the HIT are smaller businesses and middle-class families in the non-group market who don’t qualify for tax credits. Those are precisely the groups who have been facing steep premium hikes in recent years—and who are especially likely to drop health insurance coverage as it gets more expensive.