By Jordan Meadows
Staff Writer
The Senate is barreling toward a major health-care showdown as enhanced Affordable Care Act (ACA) subsidies are set to expire at the end of the year, threatening steep premium hikes for more than 20 million Americans.
Without congressional action, subsidies will revert to their original 2010 levels, driving up out-of-pocket costs and likely pushing many people out of the insurance marketplace. Yet Republicans remain sharply divided over how to respond, making an extension increasingly unlikely in the short term.
The leading Republican proposal, from Sens. Mike Crapo of Idaho and Bill Cassidy of Louisiana, would replace the enhanced tax credits with government-funded health savings accounts—$1,000 for adults under 50 and $1,500 for those aged 50 to 65, available to people earning up to 700% of the federal poverty level. To access the funds, enrollees would have to purchase plans on the ACA exchanges, which offer lower premiums but carry deductibles averaging around $7,000. This approach aligns with former President Donald Trump’s push for “direct payments” and reflects longstanding GOP arguments that money should flow directly to patients rather than into federal subsidies.
Several competing GOP proposals further underscore the party’s disunity.
Sens. Susan Collins and Bernie Moreno have introduced a bill to extend the enhanced subsidies for two years while adding income caps and minimum premium payments aimed at curbing fraud. Sen. Roger Marshall wants a one-year extension before shifting to HSA-style accounts, while Sen. Rick Scott has floated “Trump Freedom Accounts,” similar to HSAs but usable for insurance premiums.
Republican leaders, however, are reluctant to bring any of these measures to a vote, fearing that doing so would expose internal divisions and fuel Democratic attacks that the GOP lacks a coherent plan to address health-care affordability. Some Republicans, including Sen. Tommy Tuberville, warn that failing to present a unified proposal could leave the party “on the wrong side of public opinion,” especially given that affordability consistently ranks as a top voter concern.
Democrats, by contrast, are unified behind their push to extend the subsidies for three years with no policy changes. They secured a vote on their plan as a condition for reopening the government after the recent record-long shutdown, although the bill is expected to fail without Republican support. Still, Democrats see strategic value in holding the vote, reinforcing public messaging on health-care affordability.
Even if the subsidies expire on January 1, the battle likely won’t end there. The next government funding deadline arrives January 30, and Democrats are signaling they may again withhold votes on a spending bill that fails to address the subsidy cliff—mirroring the strategy that helped trigger the October 1 shutdown. With Republicans historically opposed to bolstering the ACA, and internal GOP disagreements over fiscal 2026 spending levels still unresolved, the January deadline could become another pressure point with shutdown risks attached.
Public polling consistently shows strong support for maintaining the ACA subsidies and widespread anxiety about rising health-care costs, dynamics that give Democrats political leverage and intensify pressure on Republicans to avoid being blamed for premium spikes.
