Congress has left town for the year without a health care deal, letting ACA subsidies that helped 22 million Americans lower their insurance costs expire on December 31—and doing nothing to stop the sharp spike in premiums that’s coming.
With ACA subsidies set to expire, families and individual Americans are bracing for an immediate financial hit. Monthly premiums for millions of marketplace enrollees could double—or even triple—without the tax credits that have kept coverage affordable. The Congressional Budget Office warns that this lapse could leave around 4 million more Americans uninsured, while analysts predict far-reaching consequences in the years ahead.
Enhanced subsidies, introduced during the COVID-19 pandemic and extended by Democrats in 2022, have made health coverage free—or nearly free—for many lower-income Americans. For higher earners, they’ve dramatically lowered premiums. These reduced costs have fueled a surge in enrollment, especially in Republican-led Southern states where coverage once lagged behind.
For months, Democrats have pushed to extend the subsidies, making it a central demand in the spending standoff that shut down the government this fall. A group of Senate Democrats even broke ranks to reopen the government, on the promise that a vote on the extension would take place in December. Yet lawmakers have now left Washington without holding that crucial vote.
Four swing-district House Republicans broke with party leadership to join a Democrat-led discharge petition, forcing a vote on a three-year subsidy extension. Speaker Mike Johnson, who refused to bring the issue to the floor before the holiday recess, will now have to do so when Congress reconvenes in the new year. The vote is expected during the week of Jan. 5, when the House returns to session.
Even if the House passes the bill next month, Senate Republicans are expected to block it, as they did with a similar Democratic proposal earlier this month. Still, some lawmakers hope it could serve as a stepping stone toward finally passing a broader health care measure.
"I do believe if the bill comes to the floor, not only will it pass, but it’ll give the Senate the ability to come back with a bipartisan compromise and actually get something passed into law," Rep. Mike Lawler of New York, one of the Republicans who backed the discharge petition, said Wednesday on NBC’s "Meet The Press Now."
Republican Sen. Susan Collins of Maine told NBC News that a House vote on the bill would "keep momentum going," but she stopped short of endorsing it.
“What we’re trying to do is to put together a bipartisan bill that would have reforms plus a two-year extension,” Collins said. “That is the best approach, in my opinion, and we’re making good progress.”
On ABC’s “This Week” with Jonathan Karl, House Minority Leader Hakeem Jeffries brushed off comments from Senate Majority Leader John Thune, who said a clean three-year extension would be dead on arrival in the Senate. Jeffries said Thune “is not serious about protecting the health care of the American people.”
“It will pass, with a bipartisan majority, and then that will put the pressure on John Thune and Senate Republicans to actually do the right thing by the American people: pass a straightforward extension of the Affordable Care Act tax credits so we can keep health care affordable for tens of millions of Americans who deserve to be able to go see a doctor when they need one,” Jeffries said.
Meanwhile, Republican Sen. Rand Paul of Kentucky said Sunday that he still opposes extending the subsidies, instead pushing an alternative health care plan focused on expanding Association Health Plans, which would let consumers band together to negotiate lower insurance premiums.
Earlier this month, Paul was the only Republican senator to vote against a GOP proposal to create government-funded health savings accounts.
“We have health care in our country for poor people. It’s called Medicaid. All of the rest of the stuff has not worked,” Paul said in an interview with Jonathan Karl on ABC. “Obamacare has been a failure. President Obama said it would bring premiums down; premiums have gone through the roof. Every time we give more subsidies, the premiums go higher.”
A Republican proposal passed by the House on Wednesday—which leaves out an extension of the subsidies—looks unlikely to gain any traction in the Senate. "I would expect the vote count if it were just purely this wouldn’t be probably the same as it was last week," Sen. Thom Tillis of North Carolina told NBC News, pointing to the repeated failure of GOP bills in the upper chamber.
For now, ACA subsidies are set to drop back to pre-pandemic levels before Congress returns, leaving millions of Americans bracing for steep premium spikes. With the open enrollment deadline fast approaching on Jan. 15, experts warn that anyone hoping to keep coverage affordable needs to act quickly.
Both parties have traded blame over rising health care costs. On Wednesday, President Donald Trump delivered a 20-minute address, blaming Democrats for soaring prices while asserting that his administration’s policies had provided relief. “It's the Unaffordable Care Act,” he said. “The Democrats are responsible.”
Meanwhile, Congressional Democrats are blaming Republicans for inaction as the expiration date for ACA subsidies rapidly approaches.
“Republicans still have a chance to lower costs on health care. But they still seem as determined not to as ever,” Democratic Sen. Elizabeth Warren of Massachusetts told Semafor.
Another looming deadline arrives in the new year: the short-term spending bill Congress passed in November, which reopened the government, will only fund operations through Jan. 30. Without a new deal by then, the government faces another shutdown.
At a rally in North Carolina on Friday, Trump told supporters that Democrats would once again "close down the government," accusing them of being "beholden" to insurance companies.
Senate Minority Leader Chuck Schumer has insisted that, come the new year, Democrats will not link a spending bill to renewed ACA subsidies, signaling a firm line in the ongoing partisan battle.
Speaking to Punchbowl News, Schumer warned that the enhanced Obamacare subsidies will expire by Jan. 30, accusing Republicans of being unable to strike a bipartisan deal. He added that Democrats see this as a win in framing health care as a top issue for voters heading into next November.
“As of Jan. 1, that is a different time than before because the ACA [subsidies] expired,” Schumer said. “On the other hand, we’d like to get an appropriations bill done. That’s a Jan. 30 deadline … We’re trying to work with the Republicans to get it done.”
“We’re working on appropriation bills to prevent another shutdown, now,” said Democrat Sen. Ben Ray Lujan of New Mexico, acknowledging the human stakes of legislative stalemate.“Let’s see what January brings. But people are hurting. Everything’s getting more expensive.”
