Senate Republicans will offer a vote on their own health care plan just weeks before Affordable Care Act subsidies expire, setting up votes on dueling Democratic and Republican proposals Thursday.
The Republican bill, sponsored by Sens. Mike Crapo (Idaho) and Bill Cassidy (Louisiana) would allow existing ACA subsidies to expire and replace them with a new two-year program in which the federal government would directly pay into health savings accounts paired with certain plans on the ACA marketplace.
People earning less than 700 percent of the federal poverty level — around $225,000 for a family of four in 2025 — would receive $1,000 if they are between the ages of 18 and 49, and $1,500 if they are between the ages of 50 and 64.
“It delivers the benefit directly to the patient, not to the insurance company, and it does it in a way that actually saves money,” said Senate Majority Leader John Thune (R-South Dakota).
Democrats put their own version forward last week. Thune promised a vote on legislation of the minority party’s choice after some Democrats broke with their leaders and voted to end the government shutdown last month.
Republicans have been under pressure to offer an alternative to the Democratic proposal, which is a three-year extension of existing ACA subsidies that will lapse at the end of the year. Extending the subsidies was Democrats’ primary demand during the 43-day shutdown.
Neither the Republican nor Democratic bill is expected to reach the necessary 60 votes in the Senate to withstand a filibuster. Republicans control the chamber 53-47. Some senators have said they’re optimistic that the parties could work on a compromise bill once they return in January — though the ACA subsidies only run through Dec. 31. Federal spending will also run out again after Jan. 31, possibly setting up another funding standoff tied to the issue.
Around 24 million Americans use the federal marketplace to buy insurance, most of whom receive the expanded ACA subsidies, which were put in place during the covid-19 pandemic. Average ACA premiums have already increased around 26 percent for 2026.
Republicans have raised concerns that the subsidies help keep the cost of health insurance high, and some see them as an outdated pandemic legacy. The Republican plan also limits federal Medicaid funding for states that provide coverage to undocumented immigrants, bars the use of federal Medicaid funding for “gender transition services,” and excludes those procedures as an essential health benefit for ACA Marketplace plans.
Democrats quickly rejected the GOP proposal.
“Their bill is junk insurance,” Senate Minority Leader Charles E. Schumer (D-New York) told reporters Tuesday. “It’s been repudiated in the past. The American people will repudiate it once again.”
Lawmakers in both chambers have been fervently working to put together a proposal that could alleviate rising health care costs. Several moderate Republicans who face competitive races in 2026 have raised concerns that failure to offer an alternative plan could hurt the GOP in the midterm elections.
The proposal from Crapo and Cassidy — the chairs of the two committees with oversight of health insurance policy — is one of at least six Senate proposals and two House plans.
House Speaker Mike Johnson (R-Louisiana) has not committed to holding a health care vote before the end of the year but is convening a group of Republican leaders Tuesday afternoon to explore options.
Theodoric Meyer contributed to this report.
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