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

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

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

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

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

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

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

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

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

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

Targeting ‘real drivers’ of cost increases

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

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

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

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

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

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

Trump wants direct payments

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

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

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

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.

The website of Connect for Health Colorado, the state's health insurance marketplace, is pictured on Aug. 27, 2025. (Photo by Chase Woodruff/Colorado Newsline)

WASHINGTON — Americans who purchase their health insurance through the Affordable Care Act marketplace are bracing for a steep rise in costs next year that many say they will not be able to afford, according to a poll released Thursday by the nonpartisan health organization KFF.

Nearly 60% of enrollees surveyed 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. 

About 90% of those polled said it would be somewhat or very difficult to afford health insurance within their budget if they could no longer purchase a plan through the ACA marketplace.

The spike in prices is predominantly due to the end-of-year expiration date for enhanced tax credits for ACA marketplace plans. Republicans in Congress have so far declined to extend the subsidies, while Democrats shut down the government in an unsuccessful attempt to continue the credits.

While increases would vary considerably based on location, income and plan type, a Sept. 30 KFF analysis projected individuals’ annual premiums would rise between around $350 and more than $1,800.

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. That doesn’t give Congress much time to broker a deal before the ability to purchase a plan for next year closes.

No progress on negotiations

The Senate is expected to vote next week on a Democratic bill to extend the subsidies, though that legislation appears unlikely to get the 60 votes needed to advance in the Republican-controlled chamber. 

The Health, Education, Labor and Pensions Committee held a hearing this week to explore short- and long-term options to bring down health care costs, but senators on that panel didn’t reach a clear consensus. 

KFF President and CEO Drew Altman said in a statement the “poll shows the range of problems Marketplace enrollees will face if the enhanced tax credits are not extended in some form, and those problems will be the poster child of the struggles Americans are having with health care costs in the midterms if Republicans and Democrats cannot resolve their differences.”

The KFF poll showed only 9% of marketplace enrollees have a lot of confidence that Republicans in Congress will address rising health insurance costs, with 24% saying they had some confidence, 25% saying they didn’t have much confidence and 42% responding they had no confidence in GOP lawmakers on that particular issue.

Blame falls to Trump

ACA marketplace enrollees would predominantly fault President Donald Trump if their overall health care costs, including premiums, co-pays and deductibles, were to increase by $1,000 next year, though Republicans and Democrats in Congress would share nearly as much blame, the survey found.

Thirty-seven percent would place the responsibility with Trump, while 33% would cite GOP lawmakers and 29% would fault Democrats with the rising costs.

Those numbers fluctuate significantly depending on a person’s political affiliation, with 65% of Republicans saying they would blame Democrats, while 20% would credit Republicans in Congress and 14% would fault Trump.

Forty-four percent of people who identified as independents said they would blame Trump, while 32% said they would cite Republicans in Congress and 23% said they would fault Democrats.

Among Democrats, 49% would blame Trump, 46% would credit congressional Republicans, with the remainder would fault members of their own party.

KFF conducted the survey of 1,350 people between Nov. 7-15. It has a margin of error of plus or minus 3 percentage points for the full sample, with a plus or minus 6 percentage points margin of error for political party affiliation questions.

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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.