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. 

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. 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.

U.S. Senate Minority Leader Chuck Schumer, D-N.Y., and House Minority Leader Hakeem Jeffries, D-N.Y., speak with reporters during a press conference in the U.S. Capitol building in Washington, D.C., on Wednesday, Dec. 3, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. Senate Democratic Leader Chuck Schumer announced Thursday the chamber will vote next week to extend enhanced tax credits for three years for people who purchase their health insurance from the Affordable Care Act marketplace, though the plan seems unlikely to get the bipartisan support needed to advance. 

While it would typically be difficult for the minority leader to schedule a floor vote, Senate Majority Leader John Thune, R-S.D., agreed that Democrats could bring up a health care bill of their choosing in exchange for voting to end the government shutdown.

Schumer told reporters in recent days to “stay tuned” for details about the legislation while maintaining all Senate Democrats were united around the proposal. The three-year plan he previewed during his floor speech appears identical to one House Democratic leaders have been pressing for in that chamber. 

“Any Republican who claims to care about premium increases on January 1 has only one realistic path, and that’s to support our bill for a simple, clean, three-year extension,” Schumer said. “If Republicans block our bill, there’s no going back. We won’t get another chance to halt these premium spikes before they kick in at the start of the new year.” 

The vote will take place next Thursday, Schumer said. 

Clock ticking on solution

Health care costs have surged to the forefront of the national conversation in recent months, with both Democrats and Republicans in Congress pledging to find solutions. Both agree much more time is needed to make larger, structural changes. 

The Senate committee in charge of health care policy held a hearing Wednesday where senators began to coalesce around extending the enhanced tax credits beyond the end-of-December sunset date. But a bipartisan bill has not yet been introduced in that chamber on that subject. 

Health, Education, Labor and Pensions Chairman Bill Cassidy, R-La., said just after the hearing wrapped up there will likely be a GOP bill, or even a bipartisan one, to counter Schumer’s bill. 

“Yeah, absolutely,” Cassidy said. “I’d like to have a plan that both sides can vote for. But there will be a Republican plan if I have anything to do with it.”

Congress has an especially brief time frame to find a short-term resolution on the expiring tax credits, which would lead the cost of ACA marketplace plans to rise by hundreds or thousands of dollars. 

Open enrollment for ACA marketplace plans ends at different times throughout the country, with some states finishing on Dec. 15. Residents of other states are able to sign up through varying dates in January, but with their coverage starting later in the year. Lawmakers are set to leave Capitol Hill on Dec. 19 for their winter holiday break. 

A poll released Thursday by the nonpartisan health organization KFF showed nearly 60% of ACA marketplace enrollees could not cover the costs of a $300 annual increase in their premiums, while an additional 20% said they couldn’t afford a $1,000 jump in prices per year. 

Gottheimer, Kiggans unveil House bipartisan bill

At the same time Schumer was speaking on the Senate floor, a bipartisan group of House lawmakers, led by New Jersey Democratic Rep. Josh Gottheimer and Virginia Republican Rep. Jen Kiggans, introduced a bill they said could address some of the short-term issues facing ACA enrollees. 

“Although we may have different opinions over the long-term solutions for reforming marketplace health care or if there are even better and cheaper options for publicly available health insurance, we agree on the many aspects of the short-term solutions,” Kiggans said. 

The legislation — which needs to pass a floor vote, make it through the Senate and garner President Donald Trump’s signature — would extend the enhanced ACA marketplace tax credits with new income caps, “guardrails for waste, fraud and abuse” and an overhaul of the pharmacy benefit manager, or PBM, system, Kiggans said. 

The bipartisan group of representatives would then move on to the second part of their plan, not included in the bill, where they would try to make more structural changes to the entire country’s health care system. 

Those bills, Kiggans said, would address hospital billing transparency, implement Health Savings Accounts and advance the Give Kids a Chance Act “to accelerate pediatric cancer treatments and expand access to life-saving therapies for children battling rare diseases.”

Gottheimer said the group wants House leaders to put their bill up for a vote before members leave town for the two-week, end-of-year break. 

“In the last month, families have seen their health insurance premiums surge as they’ve shopped for insurance during open enrollment because enhanced premium tax credits are set to expire, as we all know, at the end of the year,” Gottheimer said. “In fact, because of this, for millions of families on the ACA, their health premiums will rise an average of 26% next year. 

“In Jersey, where we live, it could be even rougher with a 175% increase. That’s $20,000 for a family of four. And that’s why we’re all here together to try to solve this problem, do something about it, and avoid a massive new tax on hard-working families,” he said.

Senators don’t see future in bipartisan House bill

Schumer and other Senate Democrats didn’t appear to take the bipartisan House plan seriously when pressed about it during an early afternoon press conference, asking reporters in the room whether Speaker Mike Johnson, R-La., would actually put it on the floor for a vote. 

“As for whatever House proposals there are, we’ll always look at something, but I don’t even see 15 Republicans supporting it right now,” Schumer said. “Sure an individual or two or three people can say this or that. It’s not going to solve the problem.”

Schumer maintained Senate Democrats’ three-year extension, which does not come with income caps or other changes to the tax credits proposed by centrist Republicans, is the best path forward.

He appeared frustrated when reporters asked him why he didn’t include changes that could have swayed at least some GOP senators to vote for the bill. 

Schumer said it wasn’t worth it for Democrats to put together a bill that a few Republicans might support when he doesn’t expect Speaker Johnson to put the bill on the floor in that chamber given strong opposition to the enhanced tax credits by “half his caucus.”

“Come on,” he said. “The fault is there, not with us.”

Louisiana Republican U.S. Sen. Bill Cassidy talks with reporters in the Dirksen Senate office building on Wednesday, Dec. 3, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — The U.S. Senate committee that oversees health care started coalescing around an approach to lower costs for Americans during a Wednesday hearing, though several hurdles lay ahead.

Republicans and Democrats on the panel appeared to accept that enhanced tax credits for people who purchase their health insurance from the Affordable Care Act marketplace should not expire at the end of the year. Just days are left for open enrollment and premiums are expected to greatly increase. 

The bipartisan momentum among a select group of senators will need to build significantly in the days ahead if an extension of the subsidies is going to speedily garner the 60 votes needed to advance in the Senate and then move through the GOP-controlled House. 

It will also need President Donald Trump’s signature to become law, and he has so far not signaled support for an extension.

“I’m hoping that we can find a bill that can get 60 votes, that can fix the problem with the exchanges for January 1, 2026,” Health, Education, Labor and Pensions Committee Chairman Bill Cassidy, R-La., said. “It shouldn’t be a Republican solution. It shouldn’t be a Democratic solution. It should be an American solution.”

Cassidy cautioned lawmakers on the panel from pressing for “grandiose ideas,” saying Congress must “have a solution for three weeks from now.”  

A ‘political problem’ seen for the GOP

But extending the ACA marketplace subsidies, possibly with tweaks, is just a short-term solution that senators on the committee agreed will need to be followed up with an overhaul of the American health care system. 

Any efforts on larger-scale legislation will bump up against the deeply entrenched politics of the Affordable Care Act, well-funded lobbyists and next year’s midterm elections, none of which will make the process easy. 

Vermont independent Sen. Bernie Sanders, the ranking member on the panel, said he appreciated Cassidy’s “sentiment about wanting to do something quickly,” but said Republicans should have focused on the expiring ACA tax credits earlier in the year, instead of leaving it until now.  

“The reason for this hearing, to be frank, is that my Republican friends understand they’ve got a political problem,” Sanders said. “Their political problem is that all over America today, people on the Affordable Care Act are opening up packages coming from the insurance companies, and guess what? Their premiums on average are doubling and in some cases in my state are tripling or quadrupling.”

Sanders said Congress should extend the enhanced ACA marketplace tax credits for another year, or two, or three, while lawmakers sort through larger, structural issues around health care costs. 

“Yes, the current system is broken. Yes, we need to create a new system,” Sanders said. “But unfortunately, we aren’t going to do it in two weeks.”

Sanders suggested the committee hold a series of hearings in the months ahead featuring leaders from other developed countries that provide health care to all of their residents.

Extensions of tax credits debated

Maine Republican Sen. Susan Collins said “there’s a limit to what we can do in this first year” and that lawmakers are “going to need a two-year plan.”

Collins indicated that she wants to see “reasonable” income caps to limit eligibility for ACA marketplace tax credits in any short-term extension that Congress may pass. 

Washington state Democratic Sen. Patty Murray said Republicans who are serious about addressing the spike in costs for ACA marketplace enrollees should work with Democrats to pass a “clean, one-year extension” of the enhanced subsidies. 

“And if their call for reforming tax credits is serious, we should look at that. We can talk about those reforms ahead of the 2027 year,” Murray said. “But I have to say, I’m not optimistic that most Republicans are serious about this because they refused to talk about this problem before right now, and I’ve been down this road before.”

Murray also rebuked Cassidy for not focusing the committee’s attention on the expiring tax credits earlier in the year by taking a swipe at his vote to confirm Health and Human Services Secretary Robert F. Kennedy Jr.

“This is about as serious as expressing concern about RFK Jr.’s anti-vax crusade after voting to make him the most powerful public health official in the country,” Murray said.

‘Reasonable caps’ backed

Alaska Republican Sen. Lisa Murkowski said members of the committee need to focus on what the next few months and years look like for Americans’ health care costs. 

“I think we’re going to need to have a short-term extension. But I think we can put reasonable caps on. I think that we can put some of the parameters that we have been talking about. There’s no great secret sauce here to how we’re going to deal with this particular dilemma that we’re in,” Murkowski said. “But we’ve got to be looking longer term to — how do we ultimately reduce these costs of care?”

Murkowski said she was also concerned about a decrease in funding for public health and prevention initiatives, before asking the witnesses appearing before the committee what their top recommendations would be for “prevention-type programs that have the strongest evidence for reducing long-term costs.”

Joel White, president of the Council for Affordable Health Coverage in Washington, D.C., said Congress should allow “premium discounts in the individual market for wellness programs,” which he said is currently illegal.

Marcie Strouse, owner and partner at Capitol Benefits Group in Des Moines, Iowa, suggested lawmakers open up health savings accounts “to allow for more holistic and preventive services.” She also said Congress could highlight “direct primary care and making sure people are actually getting the care that they need.”

Dr. Claudia M. Fegan, national coordinator at Physicians for a National Health Program in Chicago, suggested enhanced primary care and screening people for diseases like cancer that can be easier to treat when caught early. 

Wisconsin Democratic Sen. Tammy Baldwin said the hearing clearly demonstrated that there is “underlying agreement that this system needs a lot of reform.”

But, she said, Congress needs to take a look at the entire health care system, not just the Affordable Care Act. 

“I want to make a point that just under 50% of Americans get their health insurance through employers or group insurance, 20% are on Medicaid, 15% on Medicare, 1% on TRICARE or VA, and just over 6% are in this market,” Baldwin said. “There are problems with this market. But I have to say that abandoning the ACA … is not going to solve the system as a whole.”

Ohio Republican Sen. Jon Husted appeared supportive of a short-term extension of the enhanced ACA tax credits to provide Congress more time to address larger issues with health care affordability.

“We can freeze the subsidies where they’re at right now for a temporary period of time. I don’t know if that’s one year or two years to help give some relief,” he said. “And by the way, just because we continue those tax credits does not drive down the cost. It transfers the burden to the taxpayer and future generations. But it is a little help right now that we both can agree on. And then we’ve got to fix it.” 

Husted said there are easily a dozen bills that Congress could take up individually to start bringing down health care costs. 

Hawley offers plan for health costs tax exemption

Missouri Republican Sen. Josh Hawley also appeared to side with extending the enhanced ACA marketplace tax credits in the short term.

“We are looking at a massive crisis unless Congress acts and acts soon,” Hawley said. “And my message is to the leadership of this body — to the leaders of the House, the leaders of the Senate —maybe it’s time we all locked ourselves in a room and got to a solution here.”

Halwey pitched a bill he just introduced to exempt health care from taxes. 

“If you pay premiums, you ought to be able to deduct that from your taxes. If you have out-of-pocket medical expenses, you ought to be able to deduct every dollar off of your taxes. You want to lower the cost of health care immediately. Do that. No taxes on health care for any American,” Hawley said. “And you set an upper limit so you don’t have rich people gaming the system. I get it. That’s fine. But let’s think about working people in this country who cannot afford health care.”

Hawley said it should be allowed whether an American itemizes on their taxes or not. 

All three panelists seemed initially supportive of the idea. 

Redoing tax credits in 2026

Cassidy said after the two-hour hearing he’s working to get support from lawmakers in both political parties for an integrated approach for next year.

“You could use the income that would be used to extend the subsidies, apply them to the bronze plan, because the bronze plan is so much less expensive. You could then put that balance into the health savings account,” Cassidy said, referring to coverage levels in plans on the ACA marketplace. “So it does continue the support using the existing mechanisms we have, but integrates the HSA, which gives first dollar coverage and could potentially lower the net deductible.”

Cassidy said Congress could extend the open enrollment period for the ACA marketplace and then fund the Health Savings Accounts, which are tax-advantaged savings accounts, before the end of March. 

“People would save their receipts and submit them for payment,” he said. “People do that all the time.”

Senate Majority Leader John Thune, R-S.D., speaks to reporters while walking to his office on Nov. 10, 2025 on Capitol Hill in Washington, D.C. (Photo by Tom Brenner/Getty Images)

WASHINGTON — Republicans and Democrats in the Senate agree that health care costs are rising too quickly and expect to vote next week on legislation that could help Americans. 

The only catch is that party leaders hadn’t decided as of Tuesday what to include in the bills. 

Senators also seemed to accept that neither proposal will garner the bipartisan support needed to advance, leaving the tens of millions of Americans who purchase their health insurance from the Affordable Care Act marketplace with complicated decisions to make before open enrollment in some states ends as soon as Dec. 15. 

ACA marketplace plans are expected to increase by 26% on average next year, though a failure by Congress to extend enhanced tax credits would lead monthly payments for subsidized enrollees to increase by 114% on average, according to analysis from the nonpartisan health organization KFF. 

“I don’t think at this point we have a clear path forward,” Senate Majority Leader John Thune said. “I don’t think the Democrats have a clear path forward.”

Vote on Democratic bill expected

Thune guaranteed a small group of Democratic senators a floor vote on a health care proposal of their choosing in exchange for their votes on the spending package that ended the government shutdown. 

Democrats are widely expected to put forward a bill to extend enhanced tax credits for people who buy their health insurance from the Affordable Care Act Marketplace. Those subsidies are set to expire at the end of the year without congressional action. 

But it isn’t clear if the Democratic bill would extend the credits for one year or a longer period. 

GOP leaders are trying to rally support around a health care proposal of their own, while acknowledging it won’t get the 60 votes needed to advance under the Senate’s legislative filibuster rules. 

Thune said Republican senators had a “robust discussion” about health care issues during their closed-door lunch, where Finance Committee Chairman Mike Crapo of Idaho and Health, Education, Labor and Pensions Committee Chairman Bill Cassidy of Louisiana presented some ideas. But no final agreements were reached. 

Thune, R-S.D., said conversations will continue ahead of the vote next week and likely afterward.

Senate Minority Leader Chuck Schumer of New York said Democrats “have a plan” but declined to say exactly what it entails.

“Stay tuned,” Schumer said. “We had a great discussion and I will tell you this: We will be focused like a laser on lowering people’s costs.”

Looking for a solution

West Virginia Sen. Shelley Moore Capito said Republican talks on health care have been “vigorous” but that they hadn’t yet “decided on the clear path.” 

Capito said her “expectation” is that GOP senators will put a bill on the floor next week to bring down the costs of health insurance premiums and health care as quickly as possible, though that hadn’t been finalized.  

“I like the idea of people having control of the money as opposed to insurance companies, where they take a 20% profit,” Capito said, echoing comments by President Donald Trump. “I think that has merit.”

Capito said senators didn’t discuss during their lunch whether to extend open enrollment or possibly reopen it next year, should Congress pass a health care bill that addresses the ACA marketplace tax credits in some way.

New Hampshire Democratic Sen. Jeanne Shaheen said there is no indication there will be bipartisan agreement to extend the enhanced ACA subsidies or any other health care proposal by next week’s vote, though bipartisan conversations continue.  

As for Democrats’ plan, Shaheen said it wasn’t “clear” what legislation party leaders will put on the floor for a vote or when they’d make that announcement. 

‘Mindful of the timeline’

North Dakota Republican Sen. John Hoeven said there is “strong support” among GOP lawmakers for making changes to how the enhanced ACA tax credits work before extending them for any length of time. 

But he said those negotiations will take more time. 

“In my opinion, if we have (the vote) next week, we probably won’t be at a point where we can get a big bipartisan agreement,” Hoeven said. “It’s more likely they’ll put something up that fails. We put something up that fails. And we keep working towards, hopefully, something that can work and that is bipartisan.”

There is a “good chance,” he said, that will happen in December or January, a timeline that would likely put a solution after open enrollment closes. 

Hoeven declined to say if a deal would extend open enrollment or include a second window for Americans to select insurance, but said Republicans are aware of the deadlines. 

“We’re very mindful of the timeline,” Hoeven said. “So all the things we’re talking about recognize that it needs to be able to take effect next year or this year.”