The US Senate is preparing to vote on two competing bills aimed at addressing the looming expiration of Affordable Care Act (ACA) subsidy support, but neither measure is expected to pass. This raises the likelihood that health insurance costs will rise to levels that many Americans may struggle to afford.
The votes, part of a deal brokered between Republican Senate Majority Leader John Thune and Democratic lawmakers who agreed to reopen the government after a lengthy shutdown, come as premium tax credits for roughly 21.8 million ACA enrollees are set to expire at month’s end. Health policy researchers at KFF estimate that without subsidies, annual premiums could more than double.
Democrats have proposed extending the subsidies for three years, while Republicans are poised to oppose that plan, arguing that the 2010 law—commonly known as Obamacare—has fallen short of its promise to lower healthcare costs and that additional tax credits are financially untenable.
Thune characterized the Democratic proposal as a three-year extension of the status quo, saying it masks the true impact of Obamacare’s rising costs in a floor speech on Wednesday.
Democrats have replied by accusing Republicans of not taking seriously their pledges to reduce the cost of living in the United States. The dispute was central to the 2024 presidential race and has been linked to a decline in Donald Trump’s public approval, as voters express concern about affordability.
Senate Minority Leader Chuck Schumer asserted that Republicans lack a credible plan to address healthcare costs, while Democrats advocate a straightforward extension to halt premium increases. Schumer has proposed extending the credits through 2028.
Thune supports a separate measure proposed by Republican senators Bill Cassidy and Mike Crapo. This plan would provide government payments of $1,000 into health savings accounts (HSAs) for those enrolled in bronze or catastrophic plans with high deductibles, plus an additional $500 for individuals aged 50 to 64. There would be restrictions on using these funds for abortion or gender-affirming care.
Both proposals require at least some bipartisan support to clear the Senate’s 60-vote threshold, but neither appears poised to reach it.
Bernie Sanders, the independent who chairs the Senate Health Committee’s ranking member, criticized the Crapo-Cassidy plan as worsening an already expensive and flawed system. He argued it would not prevent premium hikes, reduce the cost of healthcare or prescription drugs, or improve access to medical care for those who get sick.
Historically, the ACA has been politically contentious. President Trump’s unsuccessful 2017 bid to repeal Obamacare contributed to Democrats gaining the House in 2018. Recent polling shows the law remains relatively popular, though Republicans have not mounted a strong repeal effort since Trump began his second term in 2025.
In other developments, Trump features in media discussions about healthcare policy. In a recent Politico interview, he criticized the ACA and expressed openness to supporting potentially targeted extensions to advance other goals, saying, “I want to give the money to the people, not to the insurance companies.”
Whatever moves the Senate makes, any bill would still need House approval, where Speaker Mike Johnson has indicated opposition to the current tax credits. Johnson suggested the House would soon introduce its own proposals to make healthcare more affordable, though he provided few specifics.
Meanwhile, a bipartisan group of moderate House members proposed extending the premium tax credits through 2027, paired with new income caps for enrollees and safeguards against fraud. This option represents another path in a deeply divided Congress as the country debates how best to contain healthcare costs while protecting consumers.
