The clock is ticking as Congress scrambles to shield millions from rising health care costs before the holidays. Enhanced premium subsidies that have made Obamacare more affordable are set to expire at month’s end, and lawmakers are rushing to act. After the Senate couldn't advance competing health care bills last week, the House now faces a similarly uncertain path with its own proposals on the table.
Speaker Mike Johnson has pledged a House vote on a Republican plan released recently. The proposal would reduce premiums for some Affordable Care Act enrollees by using a cost-sharing reduction mechanism, but it would not extend the Covid-era subsidies beyond their current expiration. Republicans also appear to intend to allow an amendment to extend ACA credits to reach the floor, aimed at pressuring swing-state Republicans like Rep. Brian Fitzpatrick of Pennsylvania to enable a vote.
The chances of passing a temporary extension of the expiring subsidies before lawmakers depart on Friday for a recess through January appear slim.
House Democratic Leader Hakeem Jeffries has dismissed the narrow GOP plan and has not signaled whether more Democrats will back partisan pressure to push bipartisan bills that would renew the Obamacare tax credits into the new year with some modifications.
Even if the House approves new health care legislation, it would still face a Senate that previously failed to reach 60 votes to advance any of the subsidies extensions, including a proposed three-year extension last week, and a president who has signaled support for sending federal aid directly to patients via health savings accounts (HSAs).
Still, Sen. Bill Cassidy, who chairs a key health committee, expressed guarded optimism on Sunday that Congress could still find a way to shield Americans from exorbitant health care costs. The Louisiana Republican told CNN’s Dana Bash that there remains a possibility of a bipartisan deal that puts money directly into patients’ pockets to cover out-of-pocket expenses while also briefly extending enhanced Obamacare credits for those who need them most.
“Republicans want to put money in patients’ pockets so they can pay their out-of-pocket costs. Democrats want to tackle the premiums,” Cassidy said. “I think a deal could be reached that does both.”
Cassidy’s own plan, which included direct contributions to HSAs but did not call for a renewal of ACA subsidies, did not pass the Senate last week. When asked on CBS’s Face the Nation why the White House did not back his proposal more strongly, Cassidy replied that the hurdle is not the other party but the Democrats. He added that he’s seeking a compromise that addresses both sides’ concerns.
After nearly all Senate Republicans opposed advancing a bill to extend ACA subsidies for three years, Senate Majority Leader Chuck Schumer warned that the onus is on GOP leadership to engage in negotiation if they truly want a solution. Schumer noted the repeated Republican votes against extending the tax credits during a period of government funding negotiations.
In a related exchange, Senate Minority Leader John Thune criticized Democrats for backing a broad, long-term ACA subsidy extension he argued was unsustainable, suggesting some senators are pursuing a political issue rather than a practical fix. Thune did not commit to bringing a two-year extension bill sponsored by two Republican senators to the floor.
Sen. Jon Ossoff, the most vulnerable Democrat in next year’s midterms, warned that failing to address the expiring tax credits would be a political disaster for Republicans. He told CNN that beyond politics, the stakes are life and death for hundreds of thousands who could lose coverage, with about a half-million in Georgia at risk of losing insurance in the state he represents.
The unfolding debate underscores a central question: can lawmakers reconcile competing priorities to keep affordable care within reach for millions as the timeline runs short?
