https://www.axios.com/2025/12/11/affordable-care-act-senate-votes-whats-next?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

There’s likely to be one more round of health care votes in the House next week after the Senate votes down two rival Affordable Care Act subsidy proposals Thursday — but they won’t get any closer to extending the enhanced subsidies.

Why it matters:

Those subsidies now appear certain to expire at the end of the year, short of a last-minute breakthrough — and out-of-pocket premium costs will more than double on average for roughly 20 million ACA enrollees.

Driving the news:

The Democratic proposal that will get a Senate vote Thursday would extend the enhanced subsidies for three years, while the Senate GOP proposal would not extend the subsidies but instead provide money for health savings accounts.

• Both will fail to get the needed 60 votes.
• Senate Majority Leader John Thune (R-S.D.) has left the door open for further bipartisan talks after both votes fail, but there is deep skepticism in both parties that any such deal is possible.
• Sen. Tim Kaine (D-Va.) said it’s possible there is “additional discussion” after the failed votes, but said the issue also might end up in a “political solution in November when people pick the side that’s for them.”

The latest: 

House GOP leaders outlined a range of possible health care options on Wednesday morning, but they have little to do with the subsidies, which weren’t included in their plans.

• GOP leaders will bring “consensus” bills to the floor next week that aim to lower health care costs, a source who attended House Republicans’ Wednesday morning conference meeting told Axios.
• Those could include expanding health savings accounts and association health plans, which allow employers to band together to purchase coverage.
• Overhauling pharmacy benefit managers with the goal of lowering drug costs was also discussed, along with funding ACA payments known as cost-sharing reductions (CSRs).

The intrigue:

On the House side, a bipartisan group of moderates including Reps. Brian Fitzpatrick (R-Pa.) and Jared Golden (D-Maine) filed a discharge petition, a procedural move to force a vote on a compromise extension plan.

• But that effort to go around House GOP leadership faces long odds against getting the required majority of the chamber to sign on.
• Modifications to the subsidies in that plan designed to win over GOP votes, like a crackdown on zero premium plans that backers say fuel fraud, could lose Democratic support due to concerns about coverage loss.

Democratic leaders have been focused on a clean three-year extension, saying that is the clearest way to address the issue with little time remaining to implement changes before the new coverage year starts Jan. 1.

• House Democratic Leader Hakeem Jeffries (N.Y.) told reporters Wednesday he has no position on the discharge petition.

The bottom line: 

There is also deep resistance to a subsidy extension among many Republicans.

• Thune has said he thinks Democratic leadership is more interested in a “political messaging” vote this week than in entertaining reforms to the subsidies that Republicans point to.
• Even if members in either chamber are able to make progress on a consensus compromise subsidy plan, which in theory could be attached to a government funding bill needed before Jan. 30, the divisive issue of abortion hangs over all of the discussions.
• Many Republicans insist on new limits preventing the subsidies from going to insurance plans that cover abortion. Democrats say that is a dangerous expansion of safeguards that already require taxpayer funds to be segregated and not pay for abortion coverage.

https://www.axios.com/2025/11/19/republican-aca-subsidies-tax-credit-alternatives-plan?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Republicans are taking a harder line against extending enhanced Affordable Care Act subsidies — and doubling down on an alternative plan that would send the money directly to consumers.

Why it matters: 

President Trump’s opposition to an extension makes it increasingly unlikely that Republicans will agree to renew the tax credits, even though it’s not clear how the GOP alternative would work or whether the party can reach a consensus.

Driving the news: 

Trump wrote on Truth Social on Tuesday that the “only” plan he will support is “sending the money directly back to the people,” and that Congress should not “waste your time” on anything else, like a subsidy extension.

• Trump didn’t elaborate on how his plan would work. The ACA already gives people financial help in buying insurance.

Some GOP proposals envision giving people money for a health savings account on top of existing ACA coverage, mitigating concerns about healthy people leaving the market.

• Senate health committee Chair Bill Cassidy (R-La.) outlined a plan on Monday that would redirect the enhanced subsidy money to an HSA to help pay out-of-pocket costs for people who chose bronze-level ACA plans, which tend to have high deductibles.
• He argued the move would direct money away from insurance companies and to consumers, and empower them to shop for health services.

Another possible outcome would be allowing people to buy cheaper, skimpier coverage that doesn’t comply with the ACA’s benefit requirements. Some policy experts warn that would destabilize the ACA markets, by prompting an exodus of healthier people.

• That would leave a sicker risk pool and prompt insurers to raise premiums, resulting in a “death spiral,” said Larry Levitt, executive vice president for health policy at KFF.
• By contrast, “I don’t think there’s any risk of, you know, a collapse or death spiral, from what Senator Cassidy is talking about,” Levitt said, though without the enhanced subsidies there would still be “potentially millions of people who just won’t be able to afford insurance at all.”

Between the lines: 

Senate Majority Leader John Thune (R-S.D.) wouldn’t rule out a bipartisan solution when asked about Trump’s comments on Tuesday, saying “we’ll see” how negotiations go and that “there’s an openness” to a deal on the GOP side.

• He said the biggest obstacle, though, could be whether Democrats agree to apply the Hyde Amendment to the subsidies and add restrictions on using the funds for abortions.

The intrigue: 

Cassidy is framing his plan as the most realistic option, given White House and House GOP leadership resistance to the subsidies.

• “The president is not going to sign a straightforward extension of premium tax credits,” Cassidy said. “So if you actually want something which can pass and get a vote on the House floor, then what the president is proposing is actually a better way.”

Yes, but: 

Democrats believe mounting public concern about rising health costs gives them the upper hand pushing for a subsidy extension.

• “Sending people a few thousand dollars while doing nothing to lower health care costs is a scheme to help the ultra-wealthy at the expense of working people with cancer or pre-existing conditions,” Senate Democratic Leader Chuck Schumer said in response to Trump’s comments.
• “Americans want Congress to extend the ACA tax credits to keep health insurance premiums from skyrocketing on January 1,” he added.

The big picture: 

The war of words is further diminishing the chances that a group of moderates in both parties can find a bipartisan agreement to extend the subsidies with some modifications favored by Republicans, like an income cap and anti-fraud measures.

• House GOP leaders have also been criticizing the subsidies. House Majority Leader Steve Scalise (R-La.) said on Fox News on Sunday that the party would be bringing forward legislation in the coming weeks on other ways to lower costs, like expanding HSAs or cracking down on pharmacy benefit managers.
• The Senate Finance Committee will hold a hearing Wednesday morning on health care costs, giving senators a chance to stake out their positions further in public.

The bottom line: 

It’s unlikely that Trump’s plan would gain the necessary 60 Senate votes to advance. But it could give Republican senators political cover if they oppose a subsidy extension.

• Republicans could still opt to use the reconciliation process to pass a bill with a simple majority. Though the White House floated the idea on Tuesday, it’s not clear if any GOP-only plan has the votes to pass.