Senate Rejects Both Parties’ Health Bills as ACA Subsidies Near Expiration

The Senate on Thursday voted down both a Democratic plan to extend enhanced Affordable Care Act subsidies and a Republican alternative, making it likely the tax credits will expire Dec. 31 and leaving roughly 22 million enrollees facing higher premiums, according to NBC News and CBS News.

Each bill failed 51-48, short of the 60 votes needed. The Democratic bill would have extended the enhanced subsidies, passed in 2021, for three years. Republican Sens. Susan Collins of Maine, Josh Hawley of Missouri, and Lisa Murkowski and Dan Sullivan of Alaska joined Democrats in support, NBC reported. The Republican bill, written by Sens. Mike Crapo of Idaho and Bill Cassidy of Louisiana, would let the subsidies lapse and instead give adults earning under 700 percent of the poverty level a tax-advantaged health savings account of $1,000 a year if under 50 or $1,500 for ages 50 to 64, while expanding cheaper “bronze” and “catastrophic” plans. Along with all Democrats, Sen. Rand Paul of Kentucky voted no.

The leaders traded sharp lines. Senate Majority Leader John Thune said the Democratic bill was “nothing more than a political messaging exercise” and defended the Republican plan: “It delivers the benefit directly to the patient, not to the insurance company.” Minority Leader Chuck Schumer called it a “when you get sick, you go broke” plan and argued the HSA money works out to about $80 a month while the plans that can use it have deductibles of $7,000 or more. President Donald Trump said he likes the “concept” of the Crapo-Cassidy bill but has not endorsed it or offered his own plan, NBC said. Hawley, who voted for the Democratic bill, said, “I think we probably still need to do something on premiums.”

The stakes for households are large. CBS News, citing the health policy group KFF, reported that out-of-pocket premiums for people now receiving the subsidies will rise 114 percent on average, or $1,016 a year, and that a family of four earning $75,000 could pay $3,368 more. CBS said about 4 million people could drop their health insurance because of the higher premiums. CBS reported that about half of adults enrolled in the ACA are small business owners, employed by a company with fewer than 25 workers, or self-employed. Michelle Sternthal of Community Catalyst warned, “We are going to see a tsunami of health costs increasing” on Jan. 1.

There is still a path, if narrow. Sen. Jeanne Shaheen of New Hampshire said another opening could come in January, NBC reported. House Republican leaders hope to hold a vote next week on their own health care bill, though none is scheduled, and some swing-district Republicans have signed two discharge petitions to force a vote on extending the subsidies over Speaker Mike Johnson’s objections. Many Republicans in both chambers want the funds to expire on schedule, NBC said, and Congress leaves for the holidays at the end of next week. Democrats hope to make the issue a theme of the 2026 midterms.