Banners from the group Save the Portage County Health Care Center. The group opposes which opposes the privatization of the county facility. (Photo courtesy of Karlene Ferrante)

As counties across Wisconsin sell off publicly-owned nursing homes to private companies, communities worry that privatization will bring understaffing, declining quality of care, and more regulatory violations, driving many residents to fight back.

After Karlene Ferrante broke her femur, she underwent major surgery and was transferred to a skilled nursing facility to recover. She spent a little over two months at the county-owned Portage County Health Care Center in Stevens Point, Wisconsin.

“​​I lucked out and got sent to the Portage County Healthcare Center. They took wonderful care of me for that whole summer and until I was able to go home,” Ferrante said. “Because of that great care that I got, I am able to walk. I have my leg. I didn’t get an infection and I didn’t fall. They were adequately staffed and they provided really good care.”

There are only two skilled nursing facilities in Stevens Point. The publicly-owned Portage County Health Care Center, which has served the community for nearly a century and has a five-star rating from the Center for Medicare and Medicaid Services (CMS), and the privately-owned Stevens Points Health Services, which has a one-star rating from CMS. Ferrante was relieved to get into the county-owned facility, but the relief faded when she returned home and learned that the county was considering selling Portage County Health Care Center to a private company.

“When I found out that they were trying to privatize it, I decided then that I’m going to work on this,” Ferrante said. “I’m not going to let that happen, because other people should be able to get the same kind of care that I got.”

Across Wisconsin, County Boards have been voting to sell their skilled nursing facilities as local communities fight the sales, especially in rural counties. In Portage County, retired professor Ferrante, a two-time patient at the Portage County Health Care Center, has joined the Save the Portage County Health Care Center group, which opposes the privatization of the county facility.

“We are the only five-star skilled nursing facility in Portage County,” said Nancy Roppe, a lifelong resident of Portage County and one of the group’s organizers. “The quality of care is stellar… people clamor to get their care here, because they know when they press the call button, somebody will respond.”

In 2018, Portage County residents approved a four-year, $5.6 million referendum to support the facility’s operations. Then, in 2022, they passed another measure authorizing tax increases to fund the construction of a new facility.

Roppe said the referendums signaled public strong support for Portage County Health Care Center, but Portage County is trying to sell the health care center to The Ensign Group, a private company which has purchased other nursing facilities in the state.

In Lincoln County, Wisconsin, the County Board voted over the summer to sell the county-owned Pine Crest Nursing Home, which had been serving the county for over 70 years, to Ensign. Just a few months after the transition from county to corporate ownership, members of the Lincoln County community have seen noticeable changes in the quality of care.

“We are already seeing the changes,” said Pastor Mike Southcombe, the senior pastor at St. Stephen’s United Church of Christ in Merrill, the county seat of Lincoln County. “The staffing is less than it was when the county ran it.”

Research consistently shows that publicly-owned facilities not only maintain higher staffing and care standards but also serve as essential safety nets for vulnerable populations, ensuring access to long-term care for residents who might otherwise be turned away by for-profit operators.

A 2022 report by the Center for Medicare Advocacy warned that privatizing county-owned nursing homes often led to lower staffing levels and diminished quality of care, as for-profit operators prioritized revenue over residents’ needs. The report found that promised cost savings rarely materialized, while accountability and public oversight were significantly reduced.

An academic study also found that privatizing county-owned nursing homes increased regulatory violations and reduced residents’ quality of care and quality of life, while failing to improve access for Medicaid recipients.

Working Class Storytelling reported that during a February town hall in Lincoln County, data presented by LeadingAge Wisconsin indicated that publicly-owned nursing homes in the state provide higher-quality care than private or nonprofit facilities.

While some Lincoln County officials said that the county did not have adequate funding to continue the operation of Pine Crest, Eileen Guthrie, a retired accountant who lives in Lincoln County and regularly volunteered at Pine Crest, crunched the numbers and found that Pine Crest was bringing in a profit.

“I started looking at all of the public records, whether they were from the finance committee or the county board, or online… I kept digging and digging,” said Guthrie, who was an active member with People for Pine Crest. When she looked through all the 2023 and 2024 financial statements, she found that Pine Crest had a positive balance upwards of $400,000 in 2023 and a positive balance above $550,000 in 2024. Guthrie said part of this positive balance was due to the state’s Medicaid reimbursement policies.

Lincoln County officials said the sale of Pine Crest would help relieve the county’s deficit, though they did not clarify what expenses were driving that deficit.

“I know not everybody’s happy about it. I understand that all of us, most of us, have people in Pine Crest, and I understand that, but I’m comfortable with Ensign, that they’ll be here and they’re going to serve the community properly,” said County Supervisor Greg Hartwig at a July County Board meeting, according to WXPR.

As the county pushed forward with the sale, many residents felt their voices were ignored. Among them was Scott Doerr, a Lincoln County resident who had worked in local factories for more than 30 years before retiring. Frustrated by the way local officials handled the Pine Crest sale, he filed paperwork to run for County Board Supervisor.

“I just felt that the county board wasn’t listening to the citizens,” Doerr said. “I’m probably going to be campaigning on giving the voice back to the people.”

The sale has raised deeper concerns about the future of the facility.

“Being county-owned was a comfort and now we have to wonder, year to year, if they’re going to sell it for profit and make things worse instead of better.” Doerr said.

That concern about the future of nursing care is shared by others who see the facility as more than just a business, but as a vital community resource.

“People have been paying taxes on [Pine Crest], volunteering at it, supporting it, all those years, with the expectation that it would be around for them when they needed it, or be around for family members when they needed it,” Southcombe said. “The population up here, as it is everywhere, is aging. The elementary schools are shrinking. The need for nursing homes in home care and just general health services is just going to increase. And we’re also going to need people to work at those places.”

For Guthrie, the sale of Pine Crest is not necessarily the end of the fight for better community services.

“The loss was significant, but there is a win in there,” Guthrie said. “All of these people worked together for the good of the community, for the good of the employees and the residents. And maybe that’ll be enough to say, okay, yeah, we lost, but there are other things that we can do, so I’m hoping that there will be more to come.”

As the Save the Portage County Health Care Center group has watched other sales, like those in Lincoln County, happen, they are working to get creative about spreading the word across the county ahead of deciding votes. They have started sharing information in newspaper ads, billboards, and online videos.

“We’ve had to go and reinvent the wheel. We’ve come up with new ways to reach the public. And how does the public react when they know? They are angry,” Ferrante said. “They’re surprised. After voting twice to support the referendums and paying the taxes to have the nursing home continue and be rebuilt, people have been shocked to learn that the current administration in the county is just selling it.”

With the county’s vote looming this week, local community advocates said the stakes feel like a matter of life and death, and they aren’t slowing down.

“Where do we find the energy to fight [for Portage County Health Care Center]? For me, I feel like I owe them,” Ferrante said. “They kind of saved my life.”

This article first appeared on The Daily Yonder and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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A sign advertises the availability of flu and COVID-19 vaccines at a pharmacy in Madison, Wisconsin. (Wisconsin Examiner photo)

Vaccination rates for influenza and COVID-19 are low in Wisconsin, and on Thursday, the Wisconsin Department of Health Services announced that two children have died within the last month: one from the flu in northeast Wisconsin and one from COVID-19 in the western part of the state.

Citing concerns for family privacy, DHS is not releasing the ages of the children. At a media briefing, Tom Haupt, the DHS respiratory epidemiologist, said they were the first deaths of people under 18 from those illnesses since the start of the flu season Oct. 1.

Although year-to-year comparisons in mid-season are difficult, “we are definitely seeing an increase in influenza and COVID-19 at this particular point,” Haupt said.

Haupt said DHS has not yet verified whether either of the two children were vaccinated. Both had “some underlying conditions that would increase their risk” for more serious illness, he said.

Five people under 18 died from flu in January and early February 2025, Haupt said. DHS monitors certain illnesses, including flu and COVID-19, through data from hospital emergency rooms, lab tests and studying municipal wastewater for evidence of the viruses responsible.

Vaccination is the best tool for preventing serious illness from both flu and COVID-19, Haupt said.

“Our vaccination status for children for both COVID-19 and influenza are very low,” he said. “We want them to be increased significantly.”

Across all ages, about 28% of Wisconsinites have been vaccinated against the flu and 10.6% against COVID-19. “These numbers are lower than what we’ve seen over the past few years and that’s very unfortunate,” Haupt said.

DHS recommends both vaccines for everyone 6 months or older. The COVID-19 and the flu shots can both be given at the same time.

Flu can have outcomes much worse than its usual symptoms.

“Influenza could lead to cardiac problems for both children and adults. It can lead to encephalitis,” Haupt said. “So, it’s not only the acute acute part of influenza, it’s what can happen later on.” With vaccination people are “protecting yourself and protecting those people who are around you.

For a third serious respiratory illness, respiratory syncytial virus, or RSV, DHS recommends the maternal RSV vaccine for expectant mothers who are 32 to 36 weeks pregnant, to protect their infants after they’re born.

DHS recommends the RSV vaccine for infants younger than 8 months if they were born to mothers who did not get the vaccine during pregnancy. DHS also recommends the vaccine for children 8 to 19 months old with a higher risk of RSV, as well as for adults 75 and older and for adults 50 to 74 years old who have an increased risk for the virus.

Haupt said doctors have told DHS that they’re encountering more vaccine hesitancy in the general public than in the past. One cause appears to be confusion about shifting recommendations from the federal Centers for Disease Control and Prevention and the CDC advisory council that makes recommendations on vaccines, he said.

Haupt said that for people hesitating about getting vaccines for themselves or their children, the “most accurate sources” for information are the state health department, local public health departments, community clinics, pharmacies and primary care doctors.

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Medical Assistant Janet Casamichana gives a flu shot to a child in Coral Gables, Fla., in September. Measles cases nationwide rose to 1,958 this year as of Dec. 16. (Photo by Joe Raedle/Getty Images)

The number of measles cases is continuing to grow, reaching 1,958 confirmed cases in 43 states through Dec. 16 and threatening to undo next year the United States’ status as a nation that has eradicated the disease, according to a report released Dec. 17 by the federal Centers for Disease Control and Prevention.

The increase of 46 cases in one week, including dozens more in South Carolina alone, raises concerns for holiday travelers.

Cases have now reached 803 in Texas, 182 in Arizona, 142 in South Carolina, 122 in Utah, and 100 in New Mexico this year.

West Texas has been the epicenter this year, but recently South Carolina has seen measles “spread quickly in unvaccinated households” in the Spartanburg County area, and 168 people were quarantined as of Dec. 16, according to the state health department.

The state urged employers to accommodate people with quarantine orders to help avoid more spread, warning that the disease is highly contagious for days before a person is aware of being sick.

Towns with low vaccination rates along the Arizona/Utah border also have seen recent outbreaks.

By July, national case numbers had already surpassed a 2019 outbreak, bringing this year’s caseload to the largest in 33 years. The last time there were more cases was 1992, when there were 2,126, according to the CDC report.

The continued outbreak, reflecting a worldwide increase in the disease but also a rise in vaccine hesitancy that has been encouraged at times by U.S. Secretary of Health Robert F. Kennedy Jr. threatens the hard-won measles eradication declared in 2000 for the United States.

The status has already been taken away from Canada, where the Pan American Health Organization found an outbreak lasting 12 months invalidated the “eradicated” status, and the United States faces an assessment next year. The CDC maintained in November that it was still possible to eliminate measles in the U.S. by ensuring every child has two doses of vaccine, but vaccination rates have been falling further away from the 95% minimum rate that limits spread.

Even as cases have risen this year, the CDC has communicated less about the highly contagious disease on social media, according to Johns Hopkins University research published this month.

The agency posted 10 times on social media this year between January and August, compared with an average of 46 times in the previous four years, according to the report, despite a rising number of cases.

Ruth Lynfield, Minnesota state epidemiologist, said vaccine hesitancy may not be the whole story of low vaccination rates, in a video interview published Dec. 16 by Contagion, an infectious disease news service. Minnesota has 26 measles cases this year, down from 70 last year.

“Overall, there is vaccine confidence. Ninety-two percent of our kids [nationally] are vaccinated against measles. However, in particular communities, that number can be quite low,” Lynfield said. “One of the reasons is not that people may be vaccine hesitant, but they have other priorities.”

Physicians can counteract some of the low rates by gaining trust and listening to concerns, she said, and also just by making things simpler with reminders and easy choices.

“One thing we can do is ensure that we can make it as simple and convenient as possible for parents and families to bring kids in to get vaccinated,” she said.

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

Recruiters discuss jobs with students at a July 2024 jobs fair at St. Edward's University in Austin, Texas. A new jobs report shows jobs nationwide rebounded after October losses, with a 64,000 gain in November. (Photo Courtesy of St. Edward’s University)

A shutdown-delayed jobs report released Dec. 16 showed an increase of 64,000 jobs in November, rebounding from a large loss of 105,000 jobs in October. Unemployment ticked higher to 4.6%, the highest since September 2021.

The October loss was the largest since December 2020, during a COVID-19 surge when jobs dropped by 183,000, according to a Stateline analysis of federal records.

The most recent report shows health care and construction added jobs in November — 46,000 and 28,000 jobs, respectively — while transportation and entertainment lost the most.

Transportation lost almost 18,000 jobs, mostly couriers and messengers, while entertainment and recreation lost 12,000 jobs, mostly in the amusement, gambling and recreation industries. The federal government dropped 6,000 jobs, while state governments gained 3,000 jobs.

State-by-state unemployment for November will be released Jan. 7 in the shutdown-affected schedule. October unemployment reports were canceled; the numbers for September showed rates rising in 25 states and falling in 21 compared with last year.

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

The U.S. Capitol in Washington, D.C., on Oct. 1, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — Republican leaders in the U.S. House will face a floor vote in early 2026 on Democrats’ plan to extend enhanced Affordable Care Act tax credits for three more years, after passing their own legislation Wednesday night that has little chance of a future in the Senate and does not address the tax credits.

The House vote on that legislation will be required after a handful of moderate Republicans signed on to a discharge petition Wednesday morning. Their dissent with leadership sent a strong signal they are frustrated with the majority’s policies and the rising cost of health care for their constituents. 

Speaker Mike Johnson, R-La., said after a morning vote series on the floor, where he was seen in a heated exchange with Republican Rep. Mike Lawler, that the two “just had some intense fellowship” and “it’s all good.”

Lawler is one of the four centrist Republicans who signed the discharge petition, putting it over the threshold of 218 to force a vote on the legislation. 

“We’re working through very complex issues as we do here all the time,” Johnson said. “Everybody’s working towards ideas — we’re keeping the productive conversation going.” 

The speaker also mounted his own defense, saying he has “not lost control of the House.”

That chamber has seen chaos and intraparty divides in the aftermath of the government shutdown, when Johnson opted to send lawmakers home for nearly two months. 

“We have the smallest majority in U.S. history,” Johnson said. “These are not normal times — there are processes and procedures in the House that are less frequently used when there are larger majorities, and when you have the luxury of having 10 or 15 people who disagree on something, you don’t have to deal with it, but when you have a razor-thin margin, as we do, then all the procedures in the book people think are on the table, and that’s the difference.”

Republicans push through ‘extremely modest’ bill

House debate on Republican leaders’ health care bill later in the day was largely along party lines, with members of both parties talking nearly as much about the Affordable Care Act as they did about the policy in the new legislation. 

Energy and Commerce Committee Chairman Brett Guthrie, R-Ky., said he believes that law, enacted during President Barack Obama’s first term, “has proven to be unaffordable and unsustainable.” 

Guthrie rebuked Democrats for approving the enhanced ACA marketplace tax credits during the coronavirus pandemic and scheduling them to expire at the end of this year, leading to the current deadlock in Congress. 

“Democrats leveraged a public health emergency to shovel hundreds of billions of dollars to big health insurance plans to mask the risk of rising unaffordability of coverage,” Guthrie said.

House Minority Leader Hakeem Jeffries, D-N.Y., urged Johnson to put the three-year ACA extension bill up for a vote this week, instead of in the new year. 

“Republicans need to bring the Affordable Care Act tax credit extension bill to the floor today,” Jeffries said. “Under no circumstances should we leave this Capitol this week, before voting on an extension of the Affordable Care Act tax credit bill that we know will pass.” 

California Republican Rep. Kevin Kiley, one of the centrists looking for bipartisan solutions on the expiring tax credits, expressed dismay at how debate on health care costs has been handled during the past few months by leaders in both political parties. 

“This whole issue encapsulates what is wrong with this institution, where party leaders focus most of their time and energy on trying to blame problems on the other side rather than trying to solve those problems,” Kiley said. 

The House Republican bill, he said, is “extremely modest and it has no chance of becoming law because it was hastily thrown together without, apparently, any bipartisan input when bipartisan support is necessary to pass any measure like this.”

“What are we supposed to tell these folks? ‘Oh, don’t worry, it’s Obama’s fault.’ Or, ‘Oh no don’t worry, we did a show vote on this Lower Health Care Premiums for All Americans Act.’ Is that going to be any consolation?” Kiley said. 

New Jersey Democratic Rep. Frank Pallone called the House GOP bill a “sham” and said without a vote to extend the expiring ACA tax credits millions of Americans will have to decide if they can afford health insurance coverage. 

“They will see prices double, triple and even quadruple,” Pallone said. “It will leave millions with the difficult decision of going without coverage because they simply cannot afford rising costs.”

The House voted 216-211 to approve the Republican health care bill, sending it to the Senate, where it’s highly unlikely it would get the bipartisan support needed to advance without significant revision. 

Senate approach

Senate Majority Leader John Thune, R-S.D., said earlier in the day he hadn’t yet decided whether to put the House Democrats’ bill on the floor if it is passed and arrives. 

“Well, we’ll see. I mean, we obviously will cross that bridge when we come to it,” Thune said. “Even if they have a sufficient number of signatures, I doubt they vote on it this week.”

Thune said the discharge petition on the three-year ACA tax credits extension is far different from the discharge petition that forced a House floor vote on a bill to require the release of the Epstein files. Files related to Jeffrey Epstein, who died in jail in 2019 awaiting federal trial on sex trafficking charges, have become a target of Congress and victims in recent months.

“That came over here pretty much unanimously, 427 to 1,” Thune said. 
“And my assumption is this discharge petition is going to be a very, probably, partisan vote.”

The Senate voted earlier this month on Democrats’ three-year ACA tax credits legislation, a move that Thune agreed to in order to get enough Democratic votes to end the government shutdown. That bill, which is identical to the House version, was unable to get the 60 votes needed to advance on a 51-48 vote. 

Both chambers are set to leave Capitol Hill later this week for their two-week winter break and won’t return to work until the week of Jan. 5. 

‘We have to do something’ 

Sen. Jeanne Shaheen said she sees the House discharge petition reaching the 218-signature threshold as “constructive.” 

The New Hampshire Democrat said “bipartisan, bicameral talks continue that are also constructive, so hopefully we can see some movement.” 

Though she is “hopeful” for a deal in January, Shaheen said “obviously, there’s a lot that needs to happen in order to get something done, but people need relief,” adding that “people in both houses and on both sides of the aisle are hearing from constituents that they want to see something done.” 

Missouri Sen. Josh Hawley — one of four Republicans who voted with Democrats to advance the three-year extension plan — reiterated his calls for lawmakers to take action to address the looming premium spikes. 

“I just think we have to do something on the cost of premiums, and I’m not locked into any one thing,” he said, acknowledging that he voted for both Democrats’ proposal and his GOP colleagues’ alternative bill. That effort also failed, at 51-48, to garner the 60 votes needed to move forward.  

“I mean, advance any solution — that’s my view, but what I think we should not do is just sit back and say, ‘Well, you know, good luck. We wish you all the best.’” 

Frustration breaks through

The House Republican bill, which Johnson released Friday evening, doesn’t extend the enhanced ACA marketplace tax credits.

It would require Pharmacy Benefit Managers “to provide employers with detailed data on prescription drug spending, rebates, spread pricing, and formulary decisions—empowering plans and workers with the transparency they deserve,” according to a summary in Johnson’s release. 

Starting in 2027, the legislation would appropriate funding for cost sharing reduction payments that the summary said would reduce health insurance premiums and stabilize the individual market. 

Johnson decided Tuesday not to allow the House to debate any amendments to the bill, blocking moderate Republicans from having their bipartisan proposal to extend the ACA marketplace tax credits with modifications taken up. 

That led to considerable frustration, and Wednesday morning, Pennsylvania Republican Reps. Brian Fitzpatrick, Rob Bresnahan and Ryan Mackenzie, along with New York’s Lawler, signed the Democrats’ discharge petition, putting it at the 218 signatures needed to force a floor vote in that chamber. 

“We’ve worked for months with both parties, in both chambers, and with the White House, all in good faith, to balance all equities and offer a responsible bridge that successfully threaded the needle,” Fitzpatrick wrote in a statement.   

“Our only request was a Floor vote on this compromise, so that the American People’s voice could be heard on this issue,” Fitzpatrick added. “That request was rejected. Then, at the request of House leadership I, along with my colleagues, filed multiple amendments, and testified at length to those amendments. House leadership then decided to reject every single one of these amendments. As I’ve stated many times before, the only policy that is worse than a clean three-year extension without any reforms, is a policy of complete expiration without any bridge. Unfortunately, it is House leadership themselves that have forced this outcome.”

Jeffries introduced petition

The discharge petition, introduced last month by House Democratic Leader  Jeffries, sat just below the signatures needed for weeks as centrist Republicans tried to broker a deal that could become law. 

When that logjam broke with the moderates’ signatures, it set up a House floor vote, but any legislation must move through the Senate as well and gain President Donald Trump’s signature. 

Without a law to extend the enhanced ACA marketplace subsidies, roughly 22 million Americans will see their health insurance premiums spike by thousands of dollars next year, if they can fit the rise in costs into their budgets. 

U.S. House Speaker Mike Johnson, R-La., talks with reporters inside the U.S. Capitol on Tuesday, Oct. 21, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Speaker Mike Johnson said Tuesday he will not allow a floor vote this week on a bipartisan amendment supported by moderate Republicans that would extend the Affordable Care Act enhanced tax credits. 

Johnson was confident that blocking the amendment would not lead centrist GOP lawmakers to oppose the Republican health care bill scheduled to get a vote Wednesday. 

“There’s about a dozen members in the conference that are in these swing districts who are fighting hard to make sure they reduce costs for all of their constituents. And many of them did want to vote on this Obamacare, COVID-era subsidy the Democrats created,” Johnson said. “We looked for a way to try to allow for that pressure release valve and it just was not to be.”

The enhanced ACA tax credits are set to expire at the end of the year, sharply increasing the cost of health insurance for the roughly 22 million Americans who purchase plans through the exchange and benefit from the subsidies. 

The House Republican health care bill wouldn’t extend those tax credits, frustrating GOP lawmakers in that chamber who are most at risk of losing their reelection bids during the November midterm elections. 

Johnson said he expects that GOP bill will pass, though he didn’t address its prospects in the Senate, where bipartisanship is needed for nearly all bills to advance under that chamber’s 60-vote legislative filibuster. 

The nonpartisan Congressional Budget Office and the staff of the Joint Committee on Taxation’s analysis of the bill shows it would reduce the federal deficit by $35.6 billion during the next decade. 

An average of 100,000 people per year would lose health insurance between 2027 and 2035, while  gross benchmark premiums for health insurance would drop by 11% on average through 2035, according to the joint analysis. 

‘Idiotic and shameful’

New York Republican Rep. Mike Lawler said in a speech on the House floor that GOP leaders’ decision to let the enhanced ACA tax credits expire was “idiotic and shameful,” especially after changes were added to address fraud and reduce costs. 

“So we have been forced to sign onto two discharge petitions,” he said. “And yet my Democratic colleagues will not join us, but for those that were at the negotiation table.”

Lawler then criticized House Minority Leader Hakeem Jeffries, of New York, for not encouraging Democrats to sign onto the bipartisan discharge petitions, noting that would likely get the 218 signatures needed to force a floor vote. He argued that’s because Jeffries “doesn’t actually want to solve the problem, he wants the issue.”

“This place is disgraceful,” Lawler said. “Everybody wants the upper hand.  Everybody wants the political advantage. They don’t actually want to do the damn work. This problem could be solved today if everybody who says they care about extending this signs the discharge.”

GOP-only bill in 2026?

When the House returns from its two-week holiday break next year, Johnson said, leaders may try to use the complex reconciliation process they used to enact the “one big, beautiful bill” to address health care. 

“What we anticipate going into the first quarter of next year is, possibly in a reconciliation package or in regular order a stand-alone, ideas just like this,” Johnson said after being asked a question about Health Savings Accounts. “We have a long list of things that we know will reduce premiums, increase access and quality of care.” 

President Donald Trump said Monday he wants Republicans to use the reconciliation process or to eliminate the Senate’s legislative filibuster to address health care and other policy priorities. 

“Republicans should knock out the filibuster and we should approve a lot of things,” Trump said. 

Senate Majority Leader John Thune, R-S.D., has said repeatedly he doesn’t intend to change or scrap the filibuster.

Direct payments or tax breaks

Trump also reiterated during the Oval Office event he would like to see Congress send direct payments to Americans to help them buy health insurance or afford health care. 

“I want all money going to the people and let the people buy their own health care. It’ll be unbelievable,” Trump said. “They’ll do a great job. They’ll get much better health care at a much lower cost.”

The Senate voted last week on two health care bills, one from Republicans and one from Democrats, but neither received the support needed to move toward a final passage vote. 

Republicans’ bill would have provided direct payments to some people enrolled in either bronze or catastrophic ACA marketplace plans with up to $1,500 in payments annually for 2026 and 2027. 

Democrats’ legislation would have extended the enhanced ACA marketplace tax credits for three years. 

Cost most urgent issue, poll finds

A bipartisan group of senators is trying to find solutions that bridge the political divide, though they are unlikely to achieve consensus on the details before the end of this week.

Thune said during a press conference Tuesday he believes there’s a way to address the rising costs of health care if Democrats continue negotiations with Republicans. 

“Our views on health care and the Democratic views on health care are very different. And I think that’s a difficult challenge that we have to figure out how to overcome,” Thune said. “But if they’re willing to accept changes that actually would put more power and control and resources in the hands of the American people and less of that in the pockets of the insurance companies, then I think there is a path forward.”

Thune acknowledged that Congress cannot pass anything this week but said he believes “there’s a potential pathway in January if Democrats are willing to come to the table on things that will actually drive down the costs of health care.”

Senate Minority Leader Chuck Schumer, D-N.Y., didn’t entirely rule out using the Jan. 30 government funding deadline to force a partial shutdown over health care, though he implied nothing can be done on the ACA tax credits after they expire at the end of December. 

“Once it expires, the toothpaste is out of the tube,” Schumer said. 

A poll released Monday by the West Health-Gallup Center on Healthcare in America shows that cost is the “most urgent” health issue facing the country, followed by access and then obesity. 

Just 57% of those polled said they were satisfied with how much they pay for their own health care and only 16% were satisfied with the total cost of health care.

Nearly two-thirds of those in the survey said they believe it’s the federal government’s responsibility “to make sure all Americans have healthcare coverage,” while 33% said it’s not. 

The first deadline for people to sign up for health insurance in 2026 through the federal health care marketplace passed Monday. With the loss of enhanced federal subsidies coverage is forecast to decline after rising for several years. (FS Productions/Getty Images)

When Chiquita Brooks-LaSure stepped into her job overseeing the federal health insurance marketplace in 2021, about 12 million Americans were purchasing their health coverage there.

By the start of 2025, that number had doubled.

Brooks-LaSure served as the administrator for the federal Center for Medicare & Medicaid Services in the Biden administration. In addition to managing the federal health insurance programs for people over 65 and people living at or below the federal poverty guidelines, CMS also manages HealthCare.gov — the health insurance marketplace created by the 2010 Affordable Care Act.

The purpose of the marketplace was to make it easier for people who had neither employer-provided  health insurance nor  Medicare or Medicaid to purchase a policy that would cover them.

 The ACA set standards for what the insurance plans are required to cover, and it established a system of nonprofit navigators to guide buyers as they sought to match their own health needs with the coverage that was available to them on the marketplace.

Early during President Joe Biden’s term, Congress passed and Biden signed legislation that increased tax credit subsidies making insurance plans purchased at HealthCare.gov much more affordable. Those enhanced tax credits brought in a flood of new insurance coverage.

“By the time we left, there were 24 million people who were enrolled” in marketplace health plans purchased through HealthCare.gov, Brooks-LaSure said during a video call with reporters last week. The call was organized by Opportunity Wisconsin, an economic issues messaging and organizing group aligned with the Democratic Party.

The federal move to give people on marketplace health plans larger  tax credits drove that increase in enrollment, health policy watchers agree.

Now the enhanced tax credits are due to expire at the end of this year. So far attempts in Congress to extend them, whether permanently or even temporarily, have gone nowhere.

On average, Brooks-LaSure said, premiums for 2026 have gone up by 26%. “For many people, they will choose to not buy health insurance coverage at all,” she said. “But others may choose to buy coverage that doesn’t cover all of their health care needs.”

Monday was the first of two red-letter days in the current history of the ACA and the health care marketplace. People hoping to get coverage starting Jan. 1 were required to sign up by the end of the day.

People can still sign up between now and Jan. 15, but policies won’t take effect until Feb. 1.

After four years of increases in the population with health insurance, the Congressional Budget Office has forecast about 4 million people will drop their coverage in 2026 without the higher subsidies.

“For 275,000 Wisconsinites, these tax credits have saved them on average almost $600 every month,” said Sen. Tammy Baldwin in another call with reporters. “Without them, these Wisconsinites will pay double, triple, or even worse for their premiums next year. And for 30,000 Wisconsinites, the price will be just too high. And they’ll choose to go without insurance.”

That was a decision that Shana Verstegen of Madison said she and her husband briefly considered. Verstegen spoke on Baldwin’s call about the choices the couple is having to make on behalf of themselves and their two sons, ages 7 and 10.

She and her husband both work for a small community gym, Verstegen said. Their employer has too few employees to be able to purchase a group health policy, so they went to the ACA marketplace.

This year they pay $460 a month, already a squeeze, but that will increase to more than $700 a month in 2026, she said.

“It’s an amount we just simply can’t afford,” Verstegen said. Realizing that they could not risk the family’s health by going without coverage, they’ve looked at other options — including possibly giving up work that has been a long-term career in order to find a job with employer-sponsored health insurance.

In the end, Verstegen said, the couple decided to increase their work hours and cancel some events in 2026 to save money to afford their higher-priced health plan.

“These are really tough and frustrating emotional and scary choices,” Verstegen said. “We’re a middle-class, healthy, hard-working family and like so many others we’re simply struggling to keep up.”

Forecasts are murky

The most recent “snapshot” from CMS on HealthCare.gov enrollment covers Nov. 1-29 this year. In Wisconsin, it shows enrollment down by almost 4,000 people compared to Nov. 1-30, 2024.

Nationally, however, the numbers are up — 5.76 million in November this year compared with 5.36 million a year ago. There isn’t enough data to confidently forecast a trend, however.

Of the people signing up in November, “a lot of those folks were probably people who already had coverage and were either renewing it or picking a new plan, but there were also likely some new enrollees,” said Louise Norris, a health policy analyst at healthinsurance.org, an insurance information website.

Norris said there could be a large upswing in enrollment ahead of Monday’s deadline for coverage starting Jan. 1. “Then again you’ll see another sort of surge as we get to mid-January” — the Jan. 15 deadline for coverage starting Feb. 1, Norris said.

Both Norris and Brooks-LaSure said that initial enrollment numbers also don’t tell the whole story.

“The people who are enrolling right now are people who absolutely know they need to have coverage,” Brooks-LaSure said. “But the number always drops when people have to pay their premiums. And so, it’s really the number in January, once people are enrolled, that we think that will be the important number to know about coverage.”

People who are not changing plans may be automatically renewed in their current plans, which can explain some of the initial signups, said Brooks-LaSure. In addition, she said, some people signing up may be opting for less expensive — but also less generous — health insurance than they purchased in the past.

HealthCare.gov classifies health plans as Gold, Silver or Bronze. Gold plans have costlier premiums but more generous coverage with lower deductibles and less cost-sharing required of patients. Bronze plans have lower premiums with higher deductibles and more cost-sharing, and Silver plans are in between.

Brooks-LaSure said she has heard anecdotally from people stepping down from Silver to Bronze plans, for example.

“Coverage is really important, of course, but your ability to actually pay when you go to the doctor is equally, if not more, important,” she said. “It may be that we don’t see the drop in the uninsured rate. We see people shifting to less generous coverage.”

Kelley Bruns, a Sawyer County resident who spoke on Baldwin’s call, said she and her husband took that route for 2026.

Bruns said her husband, a veteran and career firefighter, had to end his career early due to work injuries and resulting disabilities.

When the premium for the policy they had in 2025 rose to more than $1,600 a month — 40% of their monthly income — they opted for a less expensive plan for 2026. That plan, however, has copayments of up to $100, a $15,000 deductible and a cap on out-of-pocket expenses of more than $21,000.

“We have to pray we don’t need surgery or any other major medical procedure,” Bruns said, “since our out-of-pocket maximum is almost half of our annual income and would be a catastrophic expense for our family.” 

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U.S. House Speaker Mike Johnson, R-La., talks with reporters during a press conference on Wednesday, Dec. 10, 2025. Also pictured are, from left, Republican Conference Chairwoman Lisa McClain of Michigan, Majority Whip Tom Emmer of Minnesota and Majority Leader Steve Scalise of Louisiana. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Republicans released a health care bill Friday evening they hope will help curb rising costs, though the measure doesn’t have the level of Democratic support needed to get through the Senate. 

The 111-page bill will likely move to the House floor next week, where Speaker Mike Johnson will need nearly every one of his members to vote to pass the legislation, an uphill battle given the vastly different views among centrists and far-right members of the party on health care issues. 

The Louisiana Republican said in a statement the bill offers “clear, responsible alternatives that will lower premium costs and increase access and health care options for all Americans.”

Democrats have been pressing for a three-year extension of the enhanced tax credits for people who purchase their insurance through the Affordable Care Act marketplace. 

So far, House and Senate Republican leadership hasn’t gotten on board with any extension of those subsidies, arguing they have led to a sharp rise in the cost of health insurance. 

GOP lawmakers have instead pursued their own legislation, but without at least some backing from Democrats, no bill will make it through the Senate’s 60-vote procedural hurdles. 

Senate Republicans tried to advance a bill earlier this week from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo but fell short of the votes needed. 

Democrats were also unsuccessful trying to move their bill to extend the ACA marketplace tax credits for three years. 

The House Republican bill, sponsored by Iowa Republican Mariannette Miller-Meeks, is unlikely to break the logjam in Congress over the rising cost of health insurance and health care, potentially leaving the issue as one the parties can debate leading up to next year’s midterm elections. 

Targeting ‘real drivers’ of cost increases

Johnson rebuked Democrats in his statement for enacting the Affordable Care Act during President Barack Obama’s first term, saying the law hasn’t made health care cost less. 

House Republicans’ new legislation, Johnson said, will address “the real drivers of health care costs to provide affordable care, increase access and choice, and restore integrity to our nation’s health care system for all Americans.”

The bill would require Pharmacy Benefit Managers “to provide employers with detailed data on prescription drug spending, rebates, spread pricing, and formulary decisions—empowering plans and workers with the transparency they deserve,” according to a summary in Johnson’s release. 

Starting in 2027, the legislation would appropriate funding for cost sharing reduction payments that the summary said would reduce health insurance premiums and stabilize the individual market. 

The House Rules Committee is scheduled to prepare the bill for floor debate on Tuesday by considering whether to allow any amendments to be considered on the floor. 

The full House will then debate the legislation later in the week before departing for the two-week holiday break. 

Trump wants direct payments

President Donald Trump, speaking from the Oval Office shortly after the bill was released, reiterated his preference that the federal government send payments directly to Americans.

“We want to give the money to the people and let the people buy their own great health care, and they’ll save a lot of money, and it’ll be great,” he said.

But Trump also appeared to signal he is going to stay out of negotiations in Congress, saying, “I leave it to them and hopefully they’re going to put great legislation on this desk right here.”

Wisconsin's health department is sticking with a recommendation that children receive the hepatitis B vaccine at birth. (Photo by John Moore/Getty Images)

Wisconsin’s health department is reaffirming longstanding recommendations that all newborns get a vaccination for hepatitis B.

The Department of Health Services announced Thursday it has sent a memo to Wisconsin vaccination providers about the vaccine.

“DHS continues to recommend that all newborns receive the hepatitis B vaccine within 24 hours of birth, and then go on to complete the standard three-dose series within the first 18 months of life,” said Dr. Ryan Westergaard, chief medical officer in the DHS bureau of communicable diseases, at a media briefing Thursday.

Hepatitis B, a viral infection, can lead to lifelong liver disease, Westergaard said, including cirrhosis and liver cancer.

“Infants and young children are particularly at high risk,” he said. A baby infected with the virus has up to a 90% chance of developing chronic liver disease, he said.

Infants can be exposed during birth or through close contact with adults and caregivers “who may not even know that they carry the virus,” Westergaard added. “That’s why vaccination early in life is so important.”

DHS issued the announcement following a federal shift in vaccine policy, eliminating a recommendation in place since 1991 for newborns to receive the hepatitis B shot. The recommendation was eliminated Dec. 5 in a vote by the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention.

In June, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. replaced all 17 members of the advisory committee with a new group of appointees, many of whom are seen as vaccine skeptics.

CDC vaccine committee overturns decades-old hepatitis B recommendation for newborns

The decision to end the recommendation for all newborns to get the hepatitis B shot dismayed the leaders of  medical organizations, including the American Medical Association and the Association of State and Territorial Health Officials.

“For more than 30 years, the hepatitis B vaccine has been used safely and effectively in newborns,” Westergaard said Thursday. Since the 1991 recommendation was put in place, hepatitis B infections in children have declined by 99%, he said.

“This recommendation is grounded in decades of research showing that the vaccine is safe and effective, and it aligns with guidance of the American Academy of Pediatrics and other leading medical groups,” Westergaard said. “So, our message today is straightforward, hepatitis B and its long-term health consequences are preventable. And routine childhood vaccination remains one of our most effective tools we have to protect children’s health and prevent lifelong disease.”

Westergaard said there has been no change in insurance coverage for the vaccine and that the hepatitis B shot remains among the vaccines available through the Vaccine for Children’s program for patients without health insurance.

ACIP also recommended blood testing for antibodies before giving the rest of the hepatitis B series shots for infants and young children, but Westergaard said that recommendation is not supported by scientific evidence.

The presence of hepatitis B antibodies in adults is a good indicator that they are protected against an infection, he said. “There’s no science suggesting that that same strategy works for newborns and children,” he added.

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The Senate on Thursday rejected legislation to extend Affordable Care Act tax credits, essentially guaranteeing that millions of Americans will see a steep rise in costs at the beginning of the year.

Senators rejected a Democratic bill to extend the subsidies for three years and a Republican alternative that would have created new health savings accounts — an unceremonious end to a monthslong effort by Democrats to prevent the COVID-19-era subsidies from expiring on Jan. 1.

Ahead of the votes, Senate Democratic Leader Chuck Schumer of New York warned Republicans that if they did not vote to extend the tax credits, “there won’t be another chance to act,” before premiums rise for many people who buy insurance off the ACA marketplaces.

“Let’s avert a disaster,” Schumer said. “The American people are watching.”

Republicans have argued that Affordable Care Act plans are too expensive and need to be overhauled. The health savings accounts in the GOP bill would give money directly to consumers instead of to insurance companies, an idea that has been echoed by President Donald Trump.

Senate Majority Leader John Thune, R-S.D., said ahead of the vote that a simple extension of the subsidies is “an attempt to disguise the real impact of Obamacare’s spiraling health care costs.”

But Democrats immediately rejected the GOP plan, saying that the accounts wouldn’t be enough to cover costs for most consumers.

The dueling Senate votes are the latest political messaging exercise in a Congress that has operated almost entirely on partisan terms, as Republicans pushed through a massive tax and spending cuts bill this summer using budget maneuvers that eliminated the need for Democratic votes. In September, Republicans tweaked Senate rules to push past a Democratic blockade of all of Trump’s nominees.

The Senate voted 51-48 not to move forward on the Democratic bill, with four Republicans — Maine Sen. Susan Collins, Missouri Sen. Josh Hawley and Alaska Sens. Lisa Murkowski and Dan Sullivan — voting with Democrats. The legislation needed 60 votes to proceed, as did the Republican bill, which was also blocked on a 51-48 vote.

No interest in compromise

Some Republicans have pushed their colleagues to extend the credits, including Sen. Thom Tillis of North Carolina, who said they should vote for a short-term extension so they can find agreement on the issue next year. “It’s too complicated and too difficult to get done in the limited time that we have left,” Tillis said Wednesday.

But there appeared to be little interest in compromise. Despite the potential for bipartisan agreement, Republicans and Democrats have never engaged in meaningful or high-level negotiations on a solution, even after a small group of centrist Democrats struck a deal with Republicans last month to end the 43-day government shutdown in exchange for a vote on extending the ACA subsidies. Most Democratic lawmakers opposed the move as many Republicans made clear that they wanted the tax credits to expire.

Still, the deal raised hopes for bipartisan compromise on health care. But that quickly faded with a lack of any real bipartisan talks.

An intractable issue

The votes were also the latest failed salvo in the debate over the Affordable Care Act, President Barack Obama’s signature law that Democrats passed along party lines in 2010 to expand access to insurance coverage.

Republicans have tried unsuccessfully since then to repeal or overhaul the law, arguing that health care is still too expensive. But they have struggled to find an alternative. In the meantime, Democrats have made the policy a central political issue in several elections, betting that the millions of people who buy health care on the government marketplaces want to keep their coverage.

“When people’s monthly payments spike next year, they’ll know it was Republicans that made it happen,” Schumer said in November, while making clear that Democrats would not seek compromise.

Even if they view it as a political win, the failed votes are a loss for Democrats who demanded an extension of the benefits as they forced a government shutdown for six weeks in October and November — and for the millions of people facing premium increases on Jan. 1.

Maine Sen. Angus King, an independent who caucuses with Democrats, said the group tried to negotiate with Republicans after the shutdown ended. But, he said, the talks became unproductive when Republicans demanded language adding new limits for abortion coverage that were a “red line” for Democrats. He said Republicans were going to “own these increases.”

A plethora of plans, but little agreement

Republicans have used the looming expiration of the subsidies to renew their longstanding criticisms of the ACA, also called Obamacare, and to try, once more, to agree on what should be done.

Thune announced earlier this week that the GOP conference had decided to vote on the bill led by Louisiana Sen. Bill Cassidy, the chairman of the Senate Health, Labor, Education and Pensions Committee, and Idaho Sen. Mike Crapo, the chairman of the Senate Finance Committee, even as several Republican senators proposed alternate ideas.

In the House, Speaker Mike Johnson, R-La., has promised a vote next week. Republicans weighed different options in a conference meeting on Wednesday, with no apparent consensus.

Republican moderates in the House who could have competitive reelection bids next year are pushing Johnson to find a way to extend the subsidies. But more conservative members want to see the law overhauled.

Rep. Kevin Kiley, R-Calif., has pushed for a temporary extension, which he said could be an opening to take further steps on health care.

If they fail to act and health care costs go up, the approval rating for Congress “will get even lower,” Kiley said.

Wisconsin Watch is a nonprofit and nonpartisan newsroom. Subscribe to our newsletters to get our investigative stories and Friday news roundup. This story is published in partnership with The Associated Press.

U.S. Senate rejects health care subsidy extension as costs are set to rise for millions of Americans is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Reading Time: 6 minutes

Click here to read highlights from the story

• Free clinics like Bread of Healing in Milwaukee and Open Arms Free Clinic in Walworth County serve as a final safety net for community members who can’t afford health care.

• They are bracing for higher demand as more residents are expected to forgo insurance as a crucial tax credit is set to expire and premiums spike.

• Clinic staff say they may need more resources to meet demand. 

• The U.S. Senate on Thursday rejected dueling plans related to helping people pay for plans on the federal marketplace.

Editor’s note: This story has been updated to note the U.S. Senate’s rejection on Thursday of legislation to address the expected rise in health care premiums.

Cars filled the small parking lot outside of Milwaukee’s Cross Lutheran Church on a recent Monday afternoon. The church’s pews sat empty, but downstairs visitors waited around folding tables. Not to hear a sermon, but to see a volunteer physician. 

Staff and volunteers walked patients past a row of dividers used to separate the “waiting room” from the folding tables where doctors and counselors filled out paperwork. 

In front of the free health clinic’s four exam rooms, two phones rang. 

“This is the Bread of Healing Clinic. Can you hold for a moment?” asked Diane Hill Horton, the free health clinic’s assistant.

Across from Hill Horton, another staff member scheduled an appointment in Spanish. 

On a typical Monday, the clinic sees up to 30 patients. Bread of Healing treated 2,400 patients in 2024 across three clinics it runs in Milwaukee. Patients typically lack any health coverage and aren’t asked to pay for their visits.

“We don’t turn anyone away,” Hill Horton said.

But without action from lawmakers in Washington, clinic staff worry that it will become harder to answer every call.

Free clinics like Bread of Healing serve as a final safety net for community members who can’t afford health care. They are bracing for higher demand as more residents are expected to forgo insurance as a crucial tax credit is set to expire and premiums spike.

Affordable Care Act premiums in Wisconsin will increase on average by 17.4% next year, a previous Wisconsin Watch analysis showed, with wide variation depending on age, income, family status and geography. Meanwhile, experts estimate more than 270,000 Wisconsinites rely on the enhanced premium tax credit to make insurance more affordable. It will expire at the end of the month without intervention. 

People without insurance are less likely to get preventative care. Bread of Healing focuses on treating chronic conditions to prevent people from overwhelming emergency rooms, said Executive Director Erica Wright.

“If we don’t try our best to move with that demand, we’re not going to be able to see as many people, and there’s going to be a lot of folks falling through the cracks,” she said.

Wright oversees all three Bread of Healing locations. While the clinics have some room to take on more patients right now, she wants to significantly increase their capacity over the next year — adding money and volunteers to serve a possible “monsoon” of demand.

“We’re never going to be able to serve everybody, we know that,” Wright said. “But I don’t want it to be where our phones are ringing off the hook and we just can’t meet at least a good chunk of the demand.”

Higher premiums and shrinking options

Ashley Bratz paid about $545 a month for a low-deductible marketplace plan this year. That same plan cost over $700 when she went to sign up for 2026.

Even with her job at Open Arms Free Clinic in Walworth County covering a portion of her health care costs, the only option in Bratz’s price range had deductibles higher than what she expects to spend.

 “It’s supposed to be reasonable, and this is not reasonable,” Bratz said.

Bratz, who works as the nurse clinic coordinator, said she did not receive enhanced marketplace subsidies this year. Those who did will face a particular shock as the tax credit expires — while also confronting rising prices and shrinking options.

The income-based tax credits have lowered some marketplace enrollees’ monthly premium payments since they became available in 2014.

In 2021, the federal government expanded those subsidies, further bringing costs down for lower-income enrollees and extending smaller subsidies to people making over four times the  federal poverty level — $62,600 a year for one person in 2025.

Without an extension, monthly premiums are expected to more than double on average nationally for subsidized enrollees, according to KFF, an independent source for health policy research.

A quarter of enrollees surveyed by KFF said they were “very likely” to go without insurance if their premiums doubled.

The U.S. Senate on Thursday rejected a Democratic plan to extend marketplace subsidies. Republicans, who have long criticized the Affordable Care Act (ACA), have instead called for a broader overhaul. The Senate also rejected a Republican plan that would have expanded access to high-deductible insurance plans and deposit $1,000 to $1,500 in enrollees’ health savings accounts — without renewing enhanced subsidies.

Sara Nichols, Open Arms Clinic executive director, is forging ahead regardless. When Bratz told her about her shrinking affordable coverage options, Nichols started working with an insurance broker to find a new plan for the clinic’s small team of paid staff.

“We cannot have health care workers not have health insurance,” Nichols said.

The move left Bratz relieved. Now she’s preparing to help more clients who can’t afford coverage or just need help navigating the complicated system.

They face challenges beyond lost subsidies and premium hikes. President Donald Trump’s “big” bill-turned law included additional changes to Medicaid funding and the ACA that are expected to increase the number of people without insurance by 10 million over the next decade, according to the Congressional Budget Office.

“We always take what is thrown at us and we figure out how to handle it,” Bratz said. “Do I think we could also use more help? Yes.”

Resources needed to meet demand

Open Arms Free Clinic is already seeing higher demand, Nichols said. 

It operates a dental clinic five days a week, and she’s considering whether further demand would require opening its medical clinic for an additional day.

That would take more volunteers and money. 

While the Legislature sent state dollars to free clinics in its latest budget, private grants and donations have been harder to secure this year, Nichols said. She expects the clinic will have to get even leaner next year.

But she won’t start turning patients away.

The clinic provides dental, medical and behavioral health to low-income people who live and work in Walworth County. Its 250 volunteers help with things like translating, nursing, greeting patients and connecting people to the clinic. They also provide vision and pharmacy services.

“I know that we have enough smart people and kind people that we’re going to come up with a solution to anything that comes up,” Nichols said.

This is far from the first time Wisconsin’s free clinics have faced big changes, said Dennis Skrajewski, the executive director of the Wisconsin Association of Free and Charitable Clinics. 

Free clinics adapted to the COVID-19 pandemic, operating with fewer volunteers and switching to telehealth services and opening vaccine programs, Skrajewski said. Then clinics prepped for increased demand in 2023 after Medicaid unwinding.

“We’re used to waking up and the world changed yesterday, so we’ll adjust,” Skrajewski said.

Wisconsin’s free and charitable clinic association is collaborating with other safety net health providers as part of the Wisconsin Owns Wellbeing initiative, which will host statewide planning meetings to strengthen the state’s safety net services. 

Clinic co-founder: ‘I just wish it weren’t needed’ 

Rick Cesar started working as a parish nurse at Cross Lutheran Church in the 1990s. He took people’s blood pressure at a weekly food pantry and ran an HIV testing site and needle exchange out of the church’s basement.

He helped co-found the Bread of Healing Clinic in 2000, a decade before the ACA passed. 

“There were so many people that had no coverage,” Cesar said.

Demand for free services persisted even after more people enrolled in marketplace plans. The clinic expanded to two other locations and hired paid staff. Cesar retired from nursing in 2019 but still regularly volunteers. He feels proud watching the clinic grow.

“I just wish it weren’t needed,” he said.

The clinic is adaptable, Cesar said, whether it’s responding to a pandemic with vaccine drives or helping clients navigate ACA changes.

“We’re going to be here and do as much as we can,” Cesar said. “But those resources, you never know how long they are going to last when the demand is so great.”

‘We don’t turn anyone away’: Wisconsin’s free clinics fill gaps as thousands expected to go uninsured is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Senate Majority Leader John Thune, R-S.D., center, joined by Senate Majority Whip John Barrasso, R-Wyo., left, and Sen. James Lankford, R-Okla., speaks to reporters following a Senate Republican policy luncheon at the U.S. Capitol on Dec. 9, 2025 in Washington, D.C.  (Photo by Heather Diehl/Getty Images)

WASHINGTON — The U.S. Senate in long-anticipated votes failed to advance legislation Thursday that would have addressed the rising cost of health insurance, leaving lawmakers deadlocked on how to curb a surge in premiums expected next year. 

Senators voted 51-48 on a Republican bill co-sponsored by Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo that would have provided funding through Health Savings Accounts for some ACA marketplace enrollees during 2026 and 2027. 

They then voted 51-48 on a measure from Democrats that would have extended enhanced tax credits for people who purchase their health insurance from the Affordable Care Act Marketplace for three years. A group of Senate Democrats in November agreed to end a government shutdown of historic length in exchange for a commitment by Republicans to hold a vote on extending the enhanced subsidies.

Republican Sens. Susan Collins of Maine, Lisa Murkowski and Dan Sullivan of Alaska voted for the Democrats’ bill. Sen. Rand Paul, R-Ky., voted against both bills. 

Neither bill received the 60 votes needed to advance under the Senate’s legislative filibuster rule. 

Senate Majority Leader John Thune, R-S.D., criticized the ACA marketplace and the subsidies for leading to large increases in the costs of health insurance. 

“Under Democrats’ plan insurance premiums will continue to spiral, American taxpayers will find themselves on the hook for ever-increasing subsidy payments,” Thune said. “And don’t think that all those payments are going to go to vulnerable Americans.”

Thune argued Democrats’ bill was only an extension of the “status quo” of a “failed, flawed, fraud program that is increasing costs at three times the rate of inflation. 

Thune said the Republican bill from Cassidy and Crapo would “help individuals to meet their out-of-pocket costs and for many individuals who don’t use their insurance or who barely use it, it would allow them to save for health care expenses down the road.”

Schumer calls GOP plan ‘mean and cruel’

Senate Minority Leader Chuck Schumer, D-N.Y., said the three-year extension bill was the only option to avoid a spike in costs for people enrolled in ACA marketplace plans. 

“By my last count, Republicans are now at nine different health care proposals and counting. And none of them give the American people the one thing they most want — a clean, simple extension of these health care tax credits,” Schumer said. “But our bill does extend these credits cleanly and simply and it’s time for Republicans to join us.”

Schumer referred to the Cassidy-Crapo proposals as “stingy” as well as “mean and cruel.”

“Under the Republican plan, the big idea is essentially to hand people about $80 a month and wish them good luck,” Schumer said. “And even to qualify for that check, listen to how bad this is, Americans would be forced onto bare-bones bronze plans with sky-high deductibles; $7,000 or $10,000 for an individual, tens of thousands for a couple.”

After the votes failed, Schumer outlined some of the guardrails Democrats would put in place regarding negotiations with GOP colleagues.

“They want to talk about health care in general and how to improve it — we’re always open to that, but we do not want what they want — favoring the insurance companies, favoring the drug companies, favoring the special interests and turning their back on the American people,” he said. 

Health Savings Accounts in GOP plan

The Cassidy-Crapo bill would have the Department of Health and Human Services deposit money into Health Savings Accounts for people enrolled in bronze or catastrophic health insurance plans purchased on the ACA marketplace in 2026 or 2027, according to a summary of the bill. 

Health Savings Accounts are tax-advantaged savings accounts that consumers can use to pay for medical expenses that are not otherwise reimbursed. They are not health insurance products.

ACA marketplace enrollees who select a bronze or catastrophic plan and make up to 700% of the federal poverty level would receive $1,000 annually if they are between the ages of 18 and 49 and $1,500 per year if they are between the ages of 50 and 64. 

That would set a threshold of $109,550 in annual income for one person, or $225,050 for a family of four, according to the 2025 federal poverty guidelines. The numbers are somewhat higher for residents of Alaska and Hawaii.  

The funding could not go toward abortion access or gender transitions, according to the Republican bill summary. 

Members of Congress have introduced several other health care proposals, including two bipartisan bills in the House that would extend the enhanced ACA marketplace tax credits for at least another year with some modifications. 

Speaker Mike Johnson, R-La., has been reluctant to bring either bipartisan bill up for a floor vote, though he may not have the option if a discharge petition filed earlier this week garners the 218 signatures needed. 

Pennsylvania Republican Rep. Brian Fitzpatrick wrote in a statement the legislation represents a “solution that can actually pass—not a political messaging exercise.”

“This bill delivers the urgent help families need now, while giving Congress the runway to keep improving our healthcare system for the long term,” Fitzpatrick wrote. “Responsible governance means securing 80 percent of what families need today, rather than risking 100 percent of nothing tomorrow.”

But Johnson said Wednesday that he will put a package of bills on the House floor next week that he believes “​​will actually reduce premiums for 100% of Americans who are on health insurance.” Details of those bills have not been disclosed.

Thune told reporters that if “somebody is successful in getting a discharge petition and a bill out of the House, obviously we’ll take a look at it. But at the moment, you know, we’re focused on the action here in the Senate, which is the side-by-side vote we’re going to have later today.” 

Alaska’s Murkowski said lawmakers can find a compromise on health care by next week “if we believe it is possible.”

Political costs

The issue of affordability and rising health care costs is likely to be central to the November midterm elections, where Democrats hope to flip the House from red to blue and gain additional seats in the Senate. 

The Democratic National Committee isn’t waiting to begin those campaigns, placing digital ads in the hometown newspapers of several Republicans up for reelection next year, including Maine’s Collins and Ohio’s Jon Husted. 

“Today’s Senate vote to extend the ACA tax credits could be the difference between life and death for many Americans,” DNC Chair Ken Martin said in a press release. “Over 20 million Americans will see their health care premiums skyrocket next year if Susan Collins, John Cornyn, Jon Husted, and Dan Sullivan do not stand with working families and vote to extend these lifesaving credits.”

White House press secretary Karoline Leavitt blasted Senate Democrats’ proposal during Thursday’s press briefing, calling it a “political show vote” meant to provide cover for Democrats, whom she blamed for creating the problem. 

Trump and Republicans would “unveil creative ideas and solutions to the health care crisis that was created by Democrats,” she said. “Chuck Schumer is not sincerely interested in lowering health care costs for the American people. He’s putting this vote on the floor knowing that it will fail so he can have another talking point that he can throw around without any real plan or action.”

Shauneen Miranda and Jacob Fischler contributed to this report. 

U.S. Senate Appropriations Committee Chairwoman Susan Collins, R-Maine, speaks with reporters inside the Capitol building in Washington, D.C., on Monday, Sept. 29, 2025. (Photo by Jennifer Shutt/States Newsroom)

The Democratic National Committee will run ads Thursday on the home pages of newspapers in a quartet of Republican senators’ hometowns, calling on the incumbents up for reelection next year to support a Democratic bill to extend health care subsidies.

The digital ads target Sens. Dan Sullivan of Alaska, Susan Collins of Maine, Jon Husted of Ohio and John Cornyn of Texas on the day the Senate is expected to vote on a Democratic proposal to extend enhanced subsidies for insurance purchased on the Affordable Care Act marketplace. 

Without the extension, premiums are projected to sharply rise next year.

“REPUBLICAN ARE DOUBLING HEALTH CARE COSTS,” one mockup of the ad provided to States Newsroom reads. “Tell Senator Collins we can’t afford their price hike.”

The ads running in states with two GOP senators also mention the one not on the ballot next year: Sens. Lisa Murkowski of Alaska, Bernie Moreno of Ohio and Ted Cruz of Texas.

“Today’s Senate vote to extend the ACA tax credits could be the difference between life and death for many Americans,” DNC Chair Ken Martin said in a press release. “Over 20 million Americans will see their health care premiums skyrocket next year if Susan Collins, John Cornyn, Jon Husted, and Dan Sullivan do not stand with working families and vote to extend these lifesaving credits.”

‘Affordability’ on the ballot

Democrats have sought to make health care costs a major issue as both parties have projected a focus on affordability issues in next year’s midterm elections that will determine control of Congress.

Senate Democrats initiated a six-week government shutdown this year in an effort to force Republicans to negotiate on the expiring subsidies, which Congress expanded during the COVID-19 pandemic.

Senate Majority Leader John Thune, R-S.D., promised a vote on a bill to address rising premiums in exchange for ending the shutdown.

The chamber will vote Thursday on a Democratic proposal that would extend the enhanced ACA marketplace tax credits for three years.

Senators will also vote Thursday on legislation from Republicans Bill Cassidy of Louisiana and Mike Crapo of Idaho that would provide up to $1,500 annually for people who buy either bronze or catastrophic health insurance plans from the ACA marketplace.

House Speaker Mike Johnson, R-La., said Wednesday that chamber would vote next week on an unspecified measure to address the expiring tax credits.

President Donald Trump said Wednesday that Republicans’ goal was to provide funding “directly to the people” to “buy their own health care.”

The Covering Wisconsin webpage. The nonprofit, housed at the University of Wisconsin Extension, is a navigator agency to help people understand their options when buying health insurance through the HealthCare.gov marketplace. (Screenshot)

About 4,000 fewer people in Wisconsin signed up at the federal HealthCare.gov marketplace in November for a health plan for next year than did in November 2024 for coverage this year, recently released numbers from the federal government show.

It’s too soon to tell for sure whether that will forecast a significant drop in health coverage through the marketplace, according to William Parke-Sutherland of the Wisconsin family policy research and advocacy group Kids Forward.

Parke-Sutherland and others who pay close attention to health care access in Wisconsin are watching those numbers closely, however.

Monday, Dec. 15, marks a critical deadline — the last day that people who purchase a health plan through the marketplace can sign up for coverage that starts Jan. 1, 2026.

The Healthcare.gov marketplace was created as part of the Affordable Care Act. Enacted in 2010 to drive down the ranks of Americans without access to health care, the ACA established the marketplace to make it easier and cheaper for people without coverage from an employer or through government programs such as Medicaid to buy health insurance.

Enhanced tax credit subsidies first enacted in 2021 on health plans sold through the marketplace have helped boost enrollment to new records over the last four years nationally and in Wisconsin. More than 300,000 state residents received their health coverage for 2025 through the marketplace.

Those enhanced subsidies expire at the end of this year, however, leading to forecasts that enrollment will decline in 2026 as the cost of insurance climbs.

“Many Wisconsinites will see their premiums double, and some will see staggering increases of over $30,000 a year,” Gov. Tony Evers said Wednesday during a press call with the ACA advocacy groups Protect Our Care and Main Street Alliance. “That’s ridiculous and unattainable for many.”

The event was held both to alert people about Monday’s open enrollment deadline and to urge voters to lobby Congress to extend the subsidies.

“Each year, the Affordable Care Act and open enrollment has ensured hundreds of thousands of Wisconsinites having life-saving health care coverage,” Evers said. “These tax credits are not luxuries — they are lifelines that make the difference between kids and families and communities getting care or going without it.”

This year, 88% of Wisconsin residents who enrolled at HealthCare.gov qualified for the enhanced subsidies and saved $644 a month on average, Evers said.

Thad Schumacher, a Fitchburg pharmacist who also joined the call, said losing coverage would lead people to forgo “their primary care visits, their medications, for chronic conditions like diabetes and hypertension, and preventative care that keeps people healthy.”

Early numbers send mixed signals

The federal Centers for Medicare & Medicaid reported that from Nov. 1 to 29 this year, 84,398 Wisconsinites enrolled in coverage through the marketplace. From Nov. 1 to Nov. 30, 2024, Dairy State enrollment totaled 88,189, according to CMS.

Nationally numbers are up, however — 5.76 million in November this year, compared with 5.36 million in November last year, according to CMS.

While Wisconsin’s decrease of less than 4,000 people signing up may look small, “It’s just hard to know what this means,” Parke-Sutherland told the Wisconsin Examiner.

In the years going back to 2022, the first month of open enrollment saw anywhere from 29% to 42% of that year’s total HealthCare.gov sign-ups, he said.

At Covering Wisconsin — a federally licensed navigator that helps guide people through the process of enrolling in HealthCare.gov plans — the volume of November calls and contacts through the navigator’s web-based chat portal have been about even with the same month last year, said Allison Espeseth, the Covering Wisconsin director.

In 2024, however, there was “a pretty big spike” in contacts in the first two weeks of December leading up to the Dec. 15 deadline for coverage to start Jan. 1.

“This year, we are definitely continuing to have people call us, but we haven’t seen that spike,” Espeseth said.

She offered several possible reasons for that. Some people may have seen higher premiums for their plans and decided to go without. Others may think that there won’t be any subsidies, despite the fact that smaller subsidies that were part of HealthCare.gov plans from the beginning remain in place.

And some have wondered whether they should hold off on signing up in case Congress does reach a deal and extend the subsidies, Espeseth noted.

“We’ve been encouraging people to please sign up regardless,” Espeseth said. “Don’t wait.”

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Abortion-rights advocate Kristin Hady helps a car navigate past protesters toward  A Preferred Women’s Health Center of Atlanta in Forest Park, Georgia, in August 2023. Independent clinics are facing fresh challenges, and at least 23 more closed this year, bringing the total to 100 since the Dobbs decision. (Photo by Ross Williams/Georgia Recorder) 

When Wisconsin Planned Parenthood clinics temporarily paused abortion services in October because of a new law halting federal Medicaid reimbursements, patients turned to the state’s two independent clinics for care. 

Demand at Affiliated Medical Services in Milwaukee quadrupled, according to clinic director Dabbie Phonekeo. 

“It happened all of a sudden. We were all scrambling to figure out what we needed to do and how we were going to accept all patients,” Phonekeo said. 

The staff secured additional funding to meet need before Wisconsin’s Planned Parenthood clinics resumed abortions, adapting under a law that bans certain reproductive health care providers from receiving federal funding until July 2026. 

“This was a reminder of why it’s so important to have independent clinics and abortion access overall,” Phonekeo said. 

At least 23 independent clinics have closed this year, according to a report released Tuesday by Abortion Care Network, compared with 12 last year.

Most were in states with abortion-rights protections, the report found. 

Independent providers face less recognition than Planned Parenthood and ongoing barriers to funding. Donations to abortion clinics and funds have waned, leading to more out-of-pocket costs for patients, States Newsroom reported last year.  

Independent clinics provide 58% of all abortions nationwide, while Planned Parenthood provides 38%, hospitals 3%, and 1% occur at physicians’ offices, according to the latest Abortion Care Network findings. 

Medication abortion, allowed during the first 10 weeks of pregnancy, has been a focus of abortion-rights advocates and opponents this year. But independent clinics are more likely to offer legal procedural abortions after that. 

More than 60% of all U.S. clinics that offer abortion care after the first trimester are independent, 85% that provide abortion at 22 weeks or later are independent, and all clinics that perform the procedure after 26 weeks are independent, according to the report. 

“While both medication and in-clinic abortion are safe and effective, people may need or prefer one method over another,” the report states. “This is especially true for patients for whom it’s not safe or feasible to terminate outside the clinic — including those experiencing intimate partner violence, minors without support at home, people experiencing homelessness, and patients who cannot take time off from work or caretaking.” 

The latest clinic closures come more than three years after the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision forced many to cease operations: 100 independent clinics closed between 2022 and 2025. 

Affiliated Medical Services in Wisconsin is one of the few independent abortion providers that was able to reopen after closing the day the nation’s highest court overturned federal abortion rights on June 24, 2022. 

The clinic reopened in March 2024 a few months after a Wisconsin judge ruled that a 19th century abortion ban was invalid, Wisconsin Examiner reported. 

Phonekeo said people were initially hesitant to book appointments at the clinic. 

“Most of our patients that we saw had asked, ‘Is this legal? Am I going to go to jail if I have an abortion today? Can we do this in Wisconsin?’ So I think a lot of patients were still afraid to be seen,” she said. 

Independent clinics could become even more significant to reproductive health care access if lawmakers permanently bar Planned Parenthood from receiving federal resources.  

Some anti-abortion groups have urged the Trump administration to disqualify Planned Parenthood as a federal vendor, States Newsroom reported in November. 

Nearly 50 Planned Parenthood clinics closed this year due to federal health officials’ cuts to Title X and Medicaid. At least 20 closed since a federal “defunding” provision that halts Medicaid funds for reproductive health care providers that offer abortion and received more than $800,000 in fiscal year 2023 took effect, according to a tally released on Nov. 12 by the national organization. 

Some of the clinics that closed did not offer abortion. And under the law, federal funding only covers abortions in extreme circumstances, so the Medicaid reimbursement ban primarily affects patients who go to Planned Parenthood for other services, like birth control, cervical cancer screening and treatment for sexually transmitted infections. 

Some independent clinics offer non-abortion care, too, but many don’t accept Medicaid, clinic directors said at a Wednesday news briefing. 

Amber Gavin is the vice president of advocacy of operations at A Woman’s Choice, an organization that has three clinics in North Carolina and one each in Florida and Virginia. She said staff members at the Charlotte location have seen an uptick in patients seeking STI testing and related services. 

Karishma Oza, chief of staff at DuPont Clinic in Washington, D.C., also said providers there have seen an increase in patients who are uninsured or underinsured since the Medicaid ban, which mostly affects Planned Parenthood, took effect. 

Phonekeo said the Wisconsin clinic hasn’t dealt with more demand for reproductive health care services beyond abortion. Still, Affiliated Medical Services offers birth control pills, IUDs, STI testing and treatment, miscarriage care and even follow-up care for medication abortion provided through online-only clinics such as Hey Jane. 

While all three clinic leaders said they don’t accept Medicaid, they offer sliding-scale payments for people who cannot afford the full cost of care. 

“We’re more than just abortion providers,” Phonekeo said. 

U.S. Sen. Josh Hawley, R-Mo., talks to reporters at the U.S. Capitol on Saturday, June 28, 2025. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — Missouri U.S. Sen. Josh Hawley is ratcheting up pressure on the U.S. Food and Drug Administration to finish a study into medication abortion and to change its prescribing guidelines, sending a letter to Commissioner Marty Makary on Wednesday that the pace of the review is “totally unacceptable.”

The letter came just one day after leading anti-abortion groups called on President Donald Trump to fire Makary, following a report from Bloomberg Law that he planned to delay the agency’s review into mifepristone until past the November midterm elections. 

Hawley wrote in the two-page letter he posted to social media that it was “unclear” whether the FDA was actually conducting a review of the current prescribing guidelines and the safety of medication abortion. 

“There are more abortions in America now than when Roe was still law,” Hawley wrote, referring to the 1973 Roe v. Wade ruling from the Supreme Court, which established the constitutional right to an abortion. “And this is largely because of the chemical abortion drug and its generics, like the one you approved.”

Hawley asked Makary to reply to three questions before Dec. 15, including whether the FDA is “conducting a comprehensive safety review of mifepristone separate from the (Risk Evaluation and Mitigation Strategies) process,” if Makary delayed any safety reviews of mifepristone and if the FDA has plans to revert prescribing guidelines to require in-person dispensing. 

President Donald Trump, asked about the timeline during a roundtable at the White House, said he would find out whether the FDA was stalling. 

“I’ll find out. I’ll ask them,” Trump said. “I don’t think they’re slow walking anything, but I’ll find out.”

A spokesperson for the Department of Health and Human Services, which includes the FDA, said that “FDA’s comprehensive scientific reviews take the time necessary to get the science right, and that is what Dr. Makary is ensuring as part of the Department’s commitment to gold-standard science and evidence-based reviews.”

Second day of pressure on Makary

Hawley’s letter continued the public pressure campaign from anti-abortion organizations and lawmakers that began Tuesday when leaders at Susan B. Anthony Pro-Life America and Live Action called for Makary to be fired over the Bloomberg Law news story reporting he had delayed the review of mifepristone over political considerations related to the midterm elections.

Americans United for Life CEO John Mize released a statement after meeting with Makary, saying it “is glaringly obvious that flawed political calculations” have stalled the FDA’s review of mifepristone, but not calling for him to lose his job over it. 

Access to mifepristone

Mifepristone is one of two pharmaceuticals used in medication abortion. It is approved for up to 10 weeks gestation and can be prescribed via telehealth and shipped to patients. 

Reducing or eliminating access to mifepristone has become a linchpin of the anti-abortion movement since the U.S. Supreme Court overturned the nationwide right to an abortion in 2022. 

Anti-abortion medical organizations, represented by Alliance Defending Freedom senior counsel Erin Morrow Hawley, tried unsuccessfully to have the Supreme Court revert the prescribing guidelines for mifepristone in 2024. 

Josh Hawley and Erin Morrow Hawley are married. 

Numerous medical organizations, including the American College of Obstetricians and Gynecologists and the American Medical Association, filed briefs to the justices in that case attesting to the safety and efficacy of medication abortion. 

“The scientific evidence is overwhelming: major adverse events occur in less than 0.32% of patients,” the groups wrote. “The risk of death is almost non-existent.”

U.S. House Speaker Mike Johnson, R-La., talks with reporters during a press conference on Wednesday, Dec. 10, 2025. Also pictured from left are Republican Conference Chairwoman Lisa McClain of Michigan, Majority Whip Tom Emmer of Minnesota and Majority Leader Steve Scalise of Louisiana. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Speaker Mike Johnson committed Wednesday to hold a vote next week on a package of bills that he said would lower health insurance premiums for hundreds of millions of Americans, not just those enrolled in Affordable Care Act plans. 

But the Louisiana Republican’s promise didn’t come with any details about which bills would be included in the package or whether the legislation will have the GOP votes needed to pass, amid vastly different views among his members about the federal government’s role in health care. 

“You’re going to see a package come together that will be on the floor next week that will actually reduce premiums for 100% of Americans who are on health insurance,” Johnson said. 

That will be a challenging task for Johnson and other House Republican leaders since they hold an especially narrow 220-213 majority. Democrats are unlikely to support GOP bills that don’t extend the enhanced tax credits for people who buy their health insurance through the ACA marketplace. Without the tax credit subsidies, costs are expected to rise sharply.

House Majority Leader Steve Scalise, R-La., said just after a closed-door meeting of House GOP lawmakers on health care that leaders were still finalizing which bills would go into the package. 

“We showed a list of what the three committees of jurisdiction have been working on for months today. And then encouraged all the members to give their feedback. And they did,” Scalise said. “A lot of members spoke today at the mic, which we want. They gave their feedback. And frankly, a lot of it was very positive about those bills.”

Senate votes Thursday

The House bills are part of a larger debate in Congress and at the White House about the rising cost of living, including health care affordability, that surged to the forefront in October and November after Democrats shut down the government. 

Senate Democrats throughout the six-week shutdown demanded a vote to extend the enhanced ACA marketplace tax credits, which are set to expire at the end of the year.

Senate Majority Leader John Thune, R-S.D., promised Democrats a floor vote on a health care bill of their choosing in exchange for votes to end the shutdown. 

The Senate is expected to vote Thursday on a Democratic bill that would extend enhanced ACA marketplace tax credits for three years.

The nonpartisan Congressional Budget Office estimates that proposal would increase the federal deficit by $83 billion during the next decade. 

That three-year extension would boost the number of people with health insurance by 400,000 in 2026, 3 million in 2027, 4 million in 2028, and 1.1 million in 2029, compared to current law. 

Senators will also vote Thursday on legislation from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo, both Republicans, that would provide up to $1,500 annually for people who buy either bronze or catastrophic health insurance plans from the ACA marketplace.

The funding would go directly into a Health Savings Account for people between the ages of 18 and 64 who make up to 700% of the federal poverty level. That would be about $109,550 for one person or $225,050 for a family of four. The funding would last for 2026 and 2027 but end after that. 

Neither proposal is expected to get the 60 votes needed to advance under the Senate’s legislative filibuster rule. Even if a bill moved through the Senate, it would still need to get a House vote, a prospect that seemed like a long shot now that House GOP leaders are putting out a package of their own. 

Abortion coverage

South Carolina Republican Rep. Ralph Norman said after the conference meeting that “the devil’s in the details” of exactly which bills go to the floor but added GOP lawmakers had begun to form a “consensus.”

Maryland Republican Rep. Andy Harris said he doesn’t believe GOP lawmakers are responsible for addressing any aspect of the Affordable Care Act, including the expiring tax credits. 

“It’s not our responsibility to fix Obamacare,” Harris said. “They broke it. They should fix it.”

Harris, chairman of the far-right Freedom Caucus, said he wouldn’t support any bill to extend the enhanced ACA marketplace tax credits unless it restricted abortion access in those health insurance plans to only cases of rape, incest, or the life of the pregnant patient. 

That issue has become a central negotiating point for many GOP lawmakers, even those who are open to extending the tax credits a little while longer. 

‘Moment of truth’

Democrats argue adding those constraints, often referred to as the Hyde Amendment, is unacceptable and would represent a new restriction on abortion access. 

“I don’t understand when you’ve had a number of Republicans in the House and the Senate say they get it, this is a disaster to have these premiums double and triple, why they want to mess around right now and put abortion politics into the middle of this,” Minnesota Democratic Sen. Amy Klobuchar said. “They know that that’s not going to work.”

Senate Minority Leader Chuck Schumer, D-N.Y., said the only proposal on the table to extend the enhanced ACA marketplace tax credits, avoiding a surge in premiums next year, is the Democratic bill. 

“Tomorrow is a moment of truth for the Republicans here in the Senate,” Schumer said. “Are they going to bring health care costs down, or will they sit by and let premiums explode for millions of Americans?”

Discharge petition on bipartisan bill

Later in the day a potential solution emerged when a bipartisan group of House lawmakers filed a discharge petition that would force a floor vote on their compromise bill if they can get at least 218 signatures. 

Pennsylvania Republican Rep. Brian Fitzpatrick wrote in a statement the legislation represents a “solution that can actually pass—not a political messaging exercise.”

“This bill delivers the urgent help families need now, while giving Congress the runway to keep improving our healthcare system for the long term,” Fitzpatrick wrote. “Responsible governance means securing 80 percent of what families need today, rather than risking 100 percent of nothing tomorrow.”

The 79-page bill, formally titled the Bipartisan Health Insurance Affordability Act, is co-sponsored by Nebraska Republican Rep. Don Bacon, Pennsylvania Republican Rep. Rob Bresnahan, North Carolina Democratic Rep. Donald Davis, Washington state Democratic Rep. Marie Gluesenkamp Perez, Maine Democratic Rep. Jared Golden, New York Republican Rep. Nicole Malliotakis and New York Democratic Rep. Tom Suozzi. 

The legislation would extend enhanced ACA marketplace tax credits through 2027 and expand access to Health Savings Accounts, among several other changes.

Golden wrote in a statement announcing the bill’s introduction Tuesday that it “implements sensible income caps” on who can receive the ACA marketplace tax credits.

“This moment requires leaders to abandon their partisan corners and govern,” Golden wrote. “Our bill provides a path out of gridlock and toward solutions.”

Gluesenkamp Perez wrote that no one “wants to shell out more cash to insurance companies or (pharmacy benefit manager) middlemen.”

“At the same time, we can’t lose sight of the fact that national health doesn’t come from insurance coverage — it hinges on people having good jobs, being able to sleep 8 hours a night, cook real food and see their kids at night,” she added. “Affordable healthcare and medicine are imperative and worth the fight, but a strong nation is longer work.”

Jacob Fischler contributed to this report.

Sen. Bill Cassidy, R-La., answers questions from reporters after chairing a hearing of the Senate Health, Education, Labor and Pensions Committee on Sept. 17, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. Senate Republicans announced Tuesday they will hold a vote on their own health care proposal later this week to counter a Democratic bill that would extend enhanced tax credits for Affordable Care Act marketplace plans for three more years.

The 32-page GOP bill would not address the expiring ACA marketplace tax credits but would send payments to certain Americans through Health Savings Accounts to cover some of the cost of health care. 

Neither measure has the 60 votes needed to advance under that chamber’s rules. That would leave the ACA marketplace subsidies to expire at the end of the year and dramatically spike the cost of health insurance for the millions of people enrolled in those plans. 

Senate Majority Leader John Thune, R-S.D., said Democrats’ bill to simply extend the enhanced ACA marketplace tax credits to offset the costs Americans pay for that insurance was unacceptable. 

“The way that the program is structured, the money goes straight to the insurance companies,” Thune said. “And the way that we think this ought to work is you ought to come up with a way in which you can deliver the benefit to the patients and not to the insurance companies.”

Thune said the Democratic bill lacks an income cap for ACA marketplace tax credits and allows $0 premiums for health insurance plans — guaranteeing the measure will fail.

Senate Democratic Leader Chuck Schumer, of New York, called the GOP proposal a “nonstarter” that would lead to “junk insurance.” He said the only way to avoid a dramatic increase in health insurance costs next year is to extend the enhanced ACA tax credits. 

“Their phony proposal is dead on arrival,” Schumer said. “The bill not only fails to extend the tax credits, it increases costs, adds tons of new abortion restrictions for women, expands junk fees and permanently funds cost-sharing reductions.”

Multiple plans

Senate Republicans have debated for weeks whether to hold a vote on a GOP plan to show the party has something to offer toward reducing health care costs. Thune promised Democrats a vote on a health care bill of their choosing in exchange for votes to end the government shutdown. 

Schumer announced last week that Democrats would hold the vote on a three-year extension of the enhanced ACA tax credits as they exist now. 

Several GOP senators, including Maine’s Susan Collins and Ohio’s Bernie Moreno, have released plans that would include an extension of the expiring tax credits while beginning to transition away from those subsidies. 

But Republican leaders ultimately decided to hold a vote on a proposal released earlier this week by Health, Education, Labor and Pensions Committee Chairman Bill Cassidy, R-La., and Finance Committee Chairman Mike Crapo, R-Idaho. 

The Cassidy-Crapo legislation would have the Department of Health and Human Services deposit money into Health Savings Accounts for people enrolled in bronze or catastrophic health insurance plans purchased on the ACA marketplace in 2026 or 2027, according to a summary of the bill. 

Health Savings Accounts are tax-advantaged savings accounts that consumers can use to pay for medical expenses that are not otherwise reimbursed. They are not health insurance products.

ACA marketplace enrollees who select a bronze or catastrophic plan and make up to 700% of the federal poverty level would receive $1,000 annually if they are between the ages of 18 and 49 and $1,500 per year if they are between the ages of 50 and 64. 

That would set a threshold of $109,550 in annual income for one person, or $225,050 for a family of four, according to the 2025 federal poverty guidelines. The numbers are somewhat higher for residents of Alaska and Hawaii.  

The funding could not go toward abortion access or gender transitions, according to the Republican bill summary. 

Proposal modeled on Trump comments

Cassidy and Crapo outlined how their proposal would work during afternoon floor speeches, where they also aired their grievances with how the Affordable Care Act has affected Americans’ health care costs. 

Crapo rebuked Democrats for establishing the enhanced ACA marketplace tax credits during the coronavirus pandemic and scheduling them to sunset at the end of this year. 

“The pattern has become clear: Democrats respond to rising premiums by throwing taxpayer dollars at the problem,” Crapo said. “Their supposedly short-term fixes only drive premiums higher and make the problem harder to solve. Leaving us with apparently no choice other than to do the same thing again and again and again.”

The GOP plan, he said, was modeled off President Donald Trump’s request to send funding directly to Americans to spend on their health care. 

“Families can use that money to cover costs not handled by their insurance policy without having to wait for insurance companies to approve their treatment decisions,” Crapo said. “Because families want the best value for their money, they will seek out the most appropriate treatment. Over time this will result in lower health care costs as providers compete for patients.”

Cassidy said the bill would not subsidize health insurance premiums but would help some Americans pay for doctor exams, dentist visits, glasses and prescriptions. 

Once eligible ACA marketplace enrollees receive that funding in their Health Savings Accounts, he said, they will shop around for better prices, including on x-rays, which are often used to determine if someone has broken a bone. 

“She’s going to say, ‘Wait a second, the x-ray is $150 here and $500 there. I’m going to where it’s cheaper, not more expensive,’” Cassidy said, giving an example. “And I can tell you when that begins to happen, the people who are more expensive begin to lower their price.”

Nurse practitioner Carol Biocic treats a Marine Corps veteran at a podiatry clinic for veterans in 2023 in Chicago. New professional student loan caps might make it more difficult for people to pursue advanced nursing degrees. (Photo by Scott Olson/Getty Images)

Zoe Clarke became a hospital registered nurse two and a half years ago, following in the footsteps of her mother and grandmother.

Clarke, an ICU nurse in Asheville, North Carolina, wants to get her master’s degree to become a nurse practitioner or a certified registered nurse anesthetist — occupations in high demand — and eventually work toward a doctoral degree.

But new borrowing limits on federal student loans may hinder her from reaching that goal.

A provision in the federal One Big Beautiful Bill Act, the tax and spending law enacted this summer, overhauls the federal student loan program for graduate students in an effort to simplify the loan process and discourage colleges from raising tuition.

To comply with the new law, the U.S. Department of Education recently issued a draft rule that would impose limits on how much graduate students can borrow — up to $20,500 per year and $100,000 in total for most students, but up to $50,000 a year and $200,000 in total for students in a new “professional” category. The category includes people studying to be medical doctors, dentists, veterinarians, pharmacists and lawyers.

Students pursuing advanced nursing degrees, however, are not included in the professional category.

Advanced practice nurses, hospital associations and other health groups say the rule will make it unaffordable for many nurses to advance their careers — disproportionately affecting communities, especially rural ones, that rely on them amid physician shortages.

Advanced nurses can provide primary care, deliver babies as nurse midwives and anesthetize surgery patients where there aren’t enough physicians to go around. They can also write some prescriptions. Advanced practice nurses also serve as college faculty in community colleges and nursing schools.

The U.S. Bureau of Labor Statistics estimates the nation will employ an additional 134,000 nurse practitioners, nurse midwives and nurse anesthetists in the next decade, 35% more than there are now. In high demand, nurse practitioners are one of the fastest-growing occupations in the nation, the bureau says.

“We depend heavily on nurse practitioners,” said Sandy Reding, a president of the California Nurses Association and vice president of National Nurses United. “But if they don’t have access to getting further education, we’re not going to see additional nurse practitioners come into the field.”

Tuition, combined with living expenses, can far exceed $50,000 a year for many post-bachelor’s nursing programs.

“Potentially, this could devastate a whole generation of nurses getting their advanced practice degrees,” Clarke said.

Some education advocates fear that losing a pipeline of advanced nursing practitioners to serve as college faculty also could lead to fewer registered and advanced nurses and other caregivers with two- and four-year degrees, because there would be fewer people to teach them.

Many advanced-degree nursing faculty are retiring. Nursing schools reported more than 2,100 full-time faculty vacancies in 2022, according to the American Nurses Association — leading to roughly 80,000 students being turned away.

States are already grappling with workforce shortfalls caused by exhausting work conditions that have led many nurses to burn out and leave the field, or leave bedside care to teach, nurses told Stateline.

In response to an uproar from nursing associations and others in health care, the Department of Education released a rebuttal last week defending its proposal, saying it is not a “value judgement about the importance of programs.”

It also said it may make changes in response to public comments. The new limits would take effect July 1, 2026.

Rural and underserved communities

Advanced practice registered nurses, known as APRNs, fill gaps in rural communities where there aren’t enough clinicians. For example, nurses needed for surgeries — nurse anesthetists, or CRNAs — make up 80% of anesthesia providers in rural counties. About a fifth of APRNs nationwide worked in rural areas in 2022, according to one survey of more than 18,800 APRNs.

“The nurse practitioners, APRNs, are a needed lifeline to help fill those gaps,” said Heidi Lucas, executive director of the Missouri Rural Health Association and former director of the state’s nurses association. “Putting barriers in the way to keep [nurses] from getting degrees — that’s just going to exacerbate the problems that we already have.”

She said Missouri will be short about 2,000 physicians next year.

The new rule cutting options for federal student loans would only worsen staffing shortages amid tenuous rural hospital budgets, said state-level observers. Hospitals already are grappling with millions of dollars in looming Medicaid cuts over the next 10 years, said Rich Rasmussen, president of the Oklahoma Hospital Association.

Nurse practitioners often serve as primary care providers, writing prescriptions and managing patient care. About 80% of them see Medicaid and Medicare patients, according to the American Association of Nurse Practitioners, citing federal data from the Centers for Medicare and Medicaid Services.

The proposal to deny advanced practice nurse practitioners the more generous loan options ignores the nation’s needs, said nurse practitioner Valerie Fuller, president of the association.

“At a time when America needs more health care providers, we can’t afford to put more obstacles in place for nurse practitioner students who want to go on and further their education and take care of the patients that need care,” said Fuller, former president of the Maine Nurse Practitioner Association. “We know it’s going to harm our workforce.”

‘Clipping the wings’

Rasmussen, of the Oklahoma Hospital Association, said he is concerned about the effect the rule will have on the pipeline for certified nurse midwives and the state’s already dwindling rural maternal health care options.

“We are clipping the wings of rural [obstetrics] to be able to blossom in our state if we’re going to put these types of restrictions on the borrowing capability of nurses who want to pursue obstetrical services in nursing as well,” he said. He added that the rules will force nurses to seek private sector loans — which don’t qualify for federal loan forgiveness programs that encourage clinicians to come work in rural areas.

Teshieka Curtis-Pugh, executive director of the South Carolina Nurses Association, is also concerned about nurse midwives. South Carolina is expected to see a shortage of 3,200 physicians by 2030.

“We also live in a state that has very poor maternal outcomes, especially for women of color. So think about, how does that impact them?” she said. “That means we don’t get the certified nurse midwives who are masters prepared, some of them are doctorally prepared, who are able to fill that gap for birth in that area.”

Diversity and opportunity for students from marginalized groups could also take a hit, said Curtis-Pugh, a registered nurse with a master’s of science in nursing. And for those going back to school while juggling parenting, federal loan dollars can help beyond tuition, she noted.

“They help that mom be able to supplement child care for their child, so that they can have child care while they go to school,” she said. “There’s tuition, there’s books, there’s keeping the lights on. They’re feeding the family they’re getting to and from.”

The exclusion from the higher, “professional” category of student loan options is especially galling after nurses’ work during the COVID-19 pandemic, said Reding, of National Nurses United.

“We were all heroes in 2020. Now, what are we?” Reding asked. “It’s a slap in the face to the nurses that go to work every day doing our very best to care for our patients, even under very adverse conditions and even facing deadly viruses.”

Clarke, the registered nurse considering a post-bachelor’s degree, said nurses’ pandemic-era devotion influenced her own career path.

“When I saw the nurses and the health care workers really working hard for their communities and sacrificing a lot, I was really inspired by that,” Clarke said. “And that’s why I went to school.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

 

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As a practicing OB-GYN in Wisconsin, I see firsthand how many of my patients rely on contraception to protect their health, manage painful conditions, and plan their futures. When a woman sits across from me in the exam room, she’s not thinking about politics. She’s thinking about how to survive her work day without severe cramps, how to manage her bleeding so she can attend class without mishap, or how to avoid threatening her life with another high-risk pregnancy. 

These situations are only a few of the reasons why the news about abandoned U.S.–funded contraceptives overseas is so alarming. This action blatantly reflects the same disregard for women’s health that now shapes national policy. And that disregard lands directly on women’s bodies. 

Under the Trump administration, the U.S. government ordered the destruction of nearly $10 million worth of U.S.–funded contraceptives, based on the false claim that birth control is an “abortifacient.” This claim is absolutely nonsensical. Contraception doesn’t end a pregnancy — it prevents one. Unfortunately, ideology, and not medicine, guided that decision, leaving lifesaving, taxpayer‑funded medicine stalled in warehouses instead of reaching women who need it. 

The full picture is even more disturbing. Several days ago, a new report found that the Trump administration left 20 of 24 U.S.–funded contraceptive shipments to waste away in Belgian warehouses. These were fully paid-for, taxpayer-funded supplies — IUDs, implants, pills, and other reproductive health essentials — intended for women in 13 countries. This is simply appalling. 

And if you think that kind of extremism stops at the water’s edge, think again. 

Back home, I see the fallout of the same ideology driving national attacks on contraception and women. 

Already, there are over 300,000 women of reproductive age in Wisconsin in need of contraception, and attacks are making this gap even worse. 

And these gaps carry real health risks, because contraception does more than prevent pregnancy — it treats endometriosis, PCOS, severe bleeding and anemia, and it reduces the risk of reproductive cancers. 

Rural clinics that once offered contraception and family-planning visits have declined in number, a trend worsened by federal policy shifts that weaken the reproductive-health safety net and leave too many women without reliable nearby options for care.

And now, with health-insurance costs already skyrocketing for many families — and monthly bills set to jump even higher if those tax credits expire — the ACA’s no-cost contraception guarantee slips further out of reach. Road block after road block after road block. 

Fortunately, Wisconsin has leaders who understand the stakes. 

Sen. Tammy Baldwin’s leadership on the “Right to Contraception Act” reflects a truth every OB‑GYN knows: contraception saves lives. Contraception reduces maternal deaths, prevents unintended pregnancies, treats reproductive-health conditions, and empowers women to build stable lives. Baldwin fights to protect contraception — what Wisconsin women rely on every day — not because it’s politically convenient, but because she understands it’s a medical necessity. 

U.S. Rep. Mark Pocan co-sponsored the “Saving Lives and Taxpayer Dollars Act” — legislation designed to stop exactly what we’re seeing in Belgium. The bill requires that U.S.–funded food and medical supplies – like the contraception sitting in Brussels at this moment – reach the people they were purchased for, instead of being left to rot or destroyed for ideological reasons. In Washington, where too many have decided contraception is a cultural wedge rather than essential health care, Pocan’s voice matters. 

The women I see in my exam room aren’t looking for a political fight. They’re looking for care that lets them stay healthy, stay safe, and stay in control of their lives — something contraception makes possible every day. 

Jeopardizing contraception — whether through wasteful negligence abroad or political interference here at home — is harmful, cruel and simply unjust. 

We in Wisconsin cannot afford to look the other way. We need leaders who will defend the right to contraception, not undermine it. 

The stakes are simple: either we protect access to basic health care, or we allow ideology to decide who gets care — and who doesn’t. 

For the women in my clinic — and for women everywhere — contraception is essential care that strengthens their health and safeguards their freedom.

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