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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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.

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.

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.”

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The amount some pay for Affordable Care Act health insurance will double when enhanced subsidies expire, but there isn’t evidence the number is 20 million.

KFF, a health policy nonprofit, estimates monthly payments for Obamacare recipients will increase, on average, $1,016 – more than doubling, from $888 in 2025 to $1,904 in 2026.

That counts increases to premiums and lost subsidies.

U.S. Sen. Bernie Sanders, I-Vermont, citing KFF, made the 20 million claim. U.S. Sen. Ron Johnson, R-Wis., said Sanders was wrong.

KFF doesn’t say how many of the 24 million Obamacare enrollees will see premiums double.

But 2 to 3 million people on the high end of income eligibility would lose all enhanced subsidies. About half could see premium payments double or triple. 

Enhanced subsidies, created in 2021, expire Dec. 31. Some Obamacare enrollees will receive lower enhanced subsidies or none. Standard subsidies remain.

This fact brief is responsive to conversations such as this one.

Sources

• KFF: ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire
• U.S. Sen. Bernie Sanders: Email
• KFF: Email
• Centers for Medicare & Medicaid Services: Health Insurance Exchanges 2025 Open Enrollment Report
• The Journalist's Resource: The battle over Affordable Care Act insurance subsidies: What to know as open enrollment looms
• NBC News: What the government shutdown's end means for Obamacare subsidies
• PolitiFact: Fact-checking Democrats’ talking points about Affordable Care Act subsidies

Will 2026 Obamacare premiums double for 20 million 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.

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Affordable Care Act premiums, expected to skyrocket in 2026 unless enhanced subsidies are extended, have increased about 118% since coverage for individuals began in 2014.

That’s three times higher than inflation (39%).

U.S. Sen. Ron Johnson, R-Wis., made the three-times claim Oct. 21, as the federal government shutdown continued. 

To end the shutdown, Democrats want to extend the enhanced Obamacare subsidies, which made more people eligible. They expire Dec. 31. 

Without enhanced subsidies, Wisconsinites could see 2026 premium increases of up to 800%, according to the state. 

The average monthly premium for a benchmark Obamacare plan was $273 in 2014; it is expected to be at least $596 in 2026.

Premiums, initially so low that insurers lost money, jumped in 2017, stayed stable since 2018 but are expected to rise more than 18% in 2026, KFF Obamacare program director Cynthia Cox said.

This fact brief is responsive to conversations such as this one.

Sources

• U.S. Bureau of Labor Statistics: CPI Inflation Calculator
• The Journalist's Resource: The battle over Affordable Care Act insurance subsidies: What to know as open enrollment looms
• Wisconsin Gov. Tony Evers: Healthcare Premiums for Wisconsinites to Skyrocket in 2026 if Republicans Fail to Extend Affordable Care Act Tax Credits
• KFF: Marketplace Average Benchmark Premiums
• Peterson-KFF: How much and why ACA Marketplace premiums are going up in 2026

Have Obamacare premiums increased three times the rate of inflation? 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.

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We found no documentation confirming a Sept. 29 statement by U.S. Sen. Ron Johnson, R-Wis., that 6 million people unknowingly received health insurance through the Affordable Care Act.

Johnson cited a report by Paragon Health Institute, a think tank aligned with the Trump administration. 

The report produced an estimate, not a count, claiming 6.4 million people were fraudulently enrolled in Obamacare. It said they were not income-eligible, including millions who “appear to be enrolled without their knowledge.”

The methodology was faulted by Blue Cross Blue Shield, the National Association of Benefits and Insurance Professionals and the American Hospital Association. 

Paragon stood by its work.

Fraud is much more common among brokers misappropriating patients’ identities than by patients, said KFF Obamacare program director Cynthia Cox and Justin Giovannelli of Georgetown University’s Center on Health Insurance Reforms.

Consumers are cautioned about offers to enroll them in Obamacare.

This fact brief is responsive to conversations such as this one.

Sources

• U.S. Sen. Ron Johnson: Email
• Paragon Health Institute: The Greater Obamacare Enrollment Fraud: The Fraud Got Much Worse in 2025
• Politico: The think tank driving health policy on Capitol Hill — and dividing Republicans
• Washington Post: As GOP eyes ACA cuts, a conservative group highlights rampant fraud
• Paragon Health Institute: Answering the Critics: How Paragon Discovered Enrollment Fraud in the ACA Exchanges
• Blue Cross Blue Shield: The facts about the individual marketplace
• National Association of Benefits and Insurance Professionals: Facts Over Fear: NABIP Rebukes Paragon’s Misleading ACA Claims
• American Hospital Association: Setting the Record Straight: Separating Fact from Fiction on Health Insurance Marketplace Fraud
• U.S. Department of Health and Human Services: Consumer Fraud in the Health Insurance Marketplace

Do 6 million people receive Obamacare health insurance without knowing it? 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.