Congress Faces Year-End Crunch as ACA Subsidies Poised to Expire

Thursday afternoon, the Senate rejected two competing measures aimed at addressing the impending expiration of Affordable Care Act subsidies, making a Jan 1 increase in premiums ever more likely. Four Republicans, Sens. Susan Collins, Dan Sullivan, Lisa Murkowski, and Josh Hawley, joined Democrats in supporting a three-year extension to the program, but fell short of the 60-vote threshold needed. The Republican plan to partially replace the lapsed subsidies with federally funded tax-advantaged health savings account also failed on a 51 to 48 vote.

The subsidies remain a growing issue leading up to the 2026 midterm elections. Research from KFF has shown that Republican-held House districts rely more heavily on ACA coverage than their Democratic counterparts. The same analysis also found broad bipartisan support for the subsidies, with nearly all Democrats, and 7 in 10 Republicans in support of their extension. If the subsidies do lapse on Jan 1, average premiums are expected to increase from $888 to $1,904, with roughly 4 million Americans losing coverage over the next decade. 

With just seven days left in the House’s legislative session, many lawmakers on both sides of the aisle face mounting pressure to signal to voters that they made a good-faith effort to avert the increase. House moderates signed, and in one case filed, discharge petitions on proposals to extend the credits. Under House rules, such petitions require a seven-day holding period after reaching 218 signatures, making a vote nearly impossible barring an intervention from Speaker Mike Johnson, who has been outspoken in his opposition to any form of extension. 

 The House is set to vote next week on several proposals to address rising healthcare costs, including transparency requirements from pharmacy benefit managers, cost sharing reductions, and policies supporting self-funded care. However, an extension of the subsidies remains notably absent. House Republicans have reportedly huddled over the addition of an amendment proposed by Rep. Brian Fitzpatrick (R-PA) to extend the tax credits two years with income limits. Fitzpatrick had previously led one of the discharge petitions.

Following the Senate vote Thursday, Sen. John Hoeven (R-N.D.) acknowledged the difficulty of reaching a compromise within the current timeline. “We’ve got to find out what can get enough consensus. It’d be great if we can get it done next week but realistically, I think we got to look at it as next week, but also January.” With both chambers set to recess at the end of next week, expectations are increasingly shifting toward negotiations extending into the new year, even as millions of Americans brace for higher premiums and the potential political fallout of a lapse becomes harder to avoid.