Affordable Care Act subsidies that help millions of Americans pay for health insurance will expire in less than a month. But razor-thin margins in Congress, partisan division and competing plans are making it less and less likely that lawmakers will find a bipartisan deal to keep the assistance going — which means some households will probably face spiking insurance costs next year.
Senate Republicans promised Democrats a mid-December vote on a plan of their choice to extend the subsidies — which were implemented in 2021 to lower health care costs during the covid-19 pandemic — in exchange for support from a group of Democrats to end the government shutdown.
Around 24 million Americans use the federal marketplace to buy insurance. Most of those people now qualify for the subsidies, and the average benchmark monthly premium on Healthcare.gov has already gone up around 26 percent for 2026.
With time dwindling, Senate Democrats still haven’t released their plan, which would extend the subsidies for an unknown duration, and House Democrats are pushing for a three-year extension. But it’s clear there are not enough Senate Republicans willing to support any extension, especially without significant changes to address GOP concerns about fraud and whether subsidized plans will cover abortion.
“I can’t even get to 13 on the back of an envelope. I can’t even get 13 people to say they’re open to it,” Sen. Brian Schatz (D-Hawaii) said, referencing the 13 Republicans who would need to join with Democrats to get around a Senate filibuster and pass a bill.
Senate Majority Leader John Thune (R-South Dakota) told reporters Tuesday that some Republican senators “want to work with [Democrats] in a constructive way on something that could be a bipartisan solution, but that hasn’t landed yet.”
Those talks appear to have stalled. Asked how close lawmakers are to a bipartisan solution, Sen. Jeanne Shaheen (D-New Hampshire), who has been a part of the discussions, said, “I think we’re not.”
Instead, Republicans are mulling their own potential solutions to lower health care costs. Moderates want to extend a tweaked version of the subsidies, while conservatives are floating bigger changes that would divert the funds to individual spending accounts or allow people to use the money to purchase lower-cost alternatives to marketplace plans — which ACA advocates say would cause the system to collapse from an exodus of healthy people from insurance pools. Some Republicans have suggested additional policy ideas that could be included in a second party-line spending bill.
Some House Republicans, mostly from swing districts, have insisted the GOP needs to extend the subsidies. One of them, Rep. Brian Fitzpatrick (R-Pennsylvania), said he is preparing to release legislation later this week that would extend them for two years with income caps for eligible recipients and other changes designed to get at least a majority in the House.
“I feel like everyone’s looking to each other to lead, so we’re just picking the ball up and doing it,” he said, adding that he is prepared to introduce a discharge petition — which can force a vote on any bill if 218 House members sign on — if House Speaker Mike Johnson (R-Louisiana) doesn’t bring the legislation up for a vote.
The White House planned to release its own health care plan last week that would have extended the subsidies, but officials canned the proposal after pushback from congressional Republicans, including Johnson.
Johnson has not committed to hold a vote on Fitzpatrick’s bill or a Democratic proposal, should it pass the Senate. Johnson and other House Republican leaders have indicated that a bipartisan compromise is not likely. They argue the Affordable Care Act has contributed to rising health care costs and that significant party-line reforms are needed — a challenging proposition in a chamber where Republicans have only three votes to spare, especially with a tight year-end deadline.
“To fix the problems that Democrats created, we’re going to have to put up the votes on our own,” Majority Leader Steve Scalise (R-Louisiana) said. “Which means we’re going to meet with all of our members, build a coalition and then bring a bill to the floor, and hopefully soon.”
Without a clear bipartisan path forward, Democrats are already signaling they plan to hammer Republicans in the 2026 midterm elections for not extending the subsidies, which are politically popular.
“We’re going to get this done,” Sen. Amy Klobuchar (D-Minnesota) told reporters Tuesday, referring to extending the subsidies. “We’re either going to get it done by forcing votes in the Senate, or we’re going to get it done by getting it on some piece of legislation or we’re going to get it done by marching through into the midterms and winning.”
Marianna Sotomayor contributed to this report.
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