President Donald Trump and some congressional Republicans are mulling a second round of party-line legislation — like Trump’s One Big Beautiful Bill Act — to pursue GOP health care goals and other priorities if a bipartisan effort fails.
Such a proposal, known as a reconciliation bill, would require near-unanimity among Republicans in both chambers, and some say there’s little appetite for another partisan policy battle ahead of the 2026 midterm elections.
But others argue that now is the time to try for a second GOP law — while Republicans still control the House, Senate and the White House and as the party splinters over extending expiring Affordable Care Act subsidies.
Sen. Lindsey Graham (R-South Carolina), chairman of the Senate Budget Committee, one of the two budget committees where the framework for reconciliation bills starts, said in an interview that he’s beginning work on a second package that would include health care policy and “a lot” of other Republican priorities.
“I think the president wants it. We’d be crazy not to do it. It’d be political malpractice,” Graham said. He said that he’s proud of the first reconciliation package enacted in July “but that’s not enough.”
“The Democrats did what, two or three? We can do at least one more,” he said. “When you have this opportunity, you should take it.”
Unlike most legislation, which can stall in the Senate because of the filibuster, reconciliation bills only require a simple majority in both chambers — making them a popular vehicle to pass partisan legislation when a party holds a trifecta. Republicans have two votes to spare in the House and three votes to spare in the Senate if they try to pass a bill along party lines. The reconciliation process was initially intended to make it easier to reduce the budget deficit, though the One Big Beautiful Bill Act is expected to drive borrowing up by trillions.
But some lawmakers want to seek bipartisan agreement before moving to a party-line approach. House Budget Committee Chairman Jodey Arrington (R-Texas) said several potential health care changes to reduce premiums could get bipartisan support, and Republicans are committed to pursuing that first.
“Then there’s a set of things that probably will be something we will have to go on our own as Republicans,” he said. “I don’t know why we would leave the tool of reconciliation in the toolbox if we have another opportunity to use it and we believe it will make the health care system more efficient.”
The task grew more complicated over the weekend. Rep. Marjorie Taylor Greene (R-Georgia) announced plans to resign from Congress in early January, winnowing down the GOP’s already-slim majority in the House to a single seat until Georgia holds a special election to replace her.
Republicans in both chambers are working to put forward their own health care proposal after the record-breaking government shutdown that concluded earlier this month.
The shutdown started because Democrats demanded Republicans agree to extend Affordable Care Act subsidies expiring at the end of the year and Republicans refused to negotiate while the government was closed. The end of the subsidies will drive up costs sharply for people who qualified for them. Senate Majority Leader John Thune (R-South Dakota) promised Democrats a vote to extend the subsidies in mid-December, but did not say whether Republicans would support it.
In the House, Greene had become a persistent thorn in the side of Republican leadership and the White House with her calls to extend the expiring tax credits.
Several moderate Republicans are pushing their party to work with Democrats to extend the subsidies before the end of the year to avoid a costly jump in health care premiums and to buy time to explore the party’s other ideas for health insurance policy changes.
Rep. Mike Flood (R-Nebraska), chair of the GOP’s pragmatism-focused Main Street Caucus, said he’s hearing from constituents about insurance premium prices.
“There’s a math issue here, people are trying to figure out what they’re going to pay,” he said. “I think it’s entirely reasonable to come up with some short-term solution to extend it and then figure out what we need to do.”
Other Republicans say they can’t support an extension of the existing subsidies and have floated more sweeping changes — such as direct payments people could use toward health care premiums or out-of-pocket health care costs — that they hope can gain Democratic support.
But White House deputy Chief of Staff James Blair said at a Bloomberg Government event last week that the administration is open to a Republican-only bill if the bipartisan effort fails.
“We’ve got to see how it works out and if not, if that path is foreclosed, there is the partisan path of reconciliation as well,” he said.
Blair said that “the president probably would like to go bigger than the Hill has the appetite for” on health care.
But he later argued reconciliation could be “the pathway” to implementing the $2,000 payments from tariff dividends that Trump has proposed — something that is not popular with many congressional Republicans, who would rather use tariff revenue to decrease the deficit.
Debates over health care dealt Trump a stinging defeat in his first term, one from which advisers say the president has yet to recover. Republicans were on the precipice of repealing much of the Affordable Care Act in 2017 when Sen. John McCain (R-Arizona) cast the tiebreaking vote to sink the legislation — offering a stoic, yet dramatic, thumbs-down on the Senate floor that elicited gasps from fellow lawmakers.
Trump has retained an interest in repealing the health care law, though he has yet to propose a substantive alternative. During his 2024 campaign for the White House, he said in a debate that he had “concepts of a plan” to replace the Affordable Care Act.
In recent weeks, he’s suggested that he would support a health care bill that would divert funds from insurance companies to households. The subsidies that are set to expire send money to insurance providers so they can offer cheaper plans than they’d otherwise be able to. Some GOP lawmakers and interest groups have suggested giving those funds to individuals to use in health savings accounts, tax-free accounts that can only be used on medical expenses.
The last Republican reconciliation bill — which made Trump’s 2017 tax cuts permanent, created new temporary tax breaks for tips and overtime and car loans, poured money into border security and defense, clawed back climate programs and made major cuts to Medicaid — has been met with more opposition than support, surveys show. A Washington Post-Ipsos poll from September found 26 percent of respondents supported the bill, 44 percent opposed it and 29 percent had no opinion. Nearly a quarter of respondents had not heard of the legislation.
Several Republicans in Congress remember how challenging the One Big Beautiful Bill was to pass and believe that there is not yet a unifying policy proposal to rally lawmakers around, especially as the 2026 midterm elections approach. For the law that passed this summer, extending the 2017 tax cuts helped hold Republicans in line.
“All the low-hanging fruit has already been picked on reconciliation,” said Flood of the Main Street Caucus. “It’s going to be tough.”
House Majority Leader Steve Scalise (R-Louisiana) said GOP leaders are discussing the possibility of a second reconciliation bill with members, but they’re still determining if there are proposals that enough Republicans would support.
But he hinted at the challenge of coming up with a policy package the whole conference can get behind: “We had a lot of ideas we wanted to put in the first reconciliation bill that didn’t have consensus.”
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