How exchange subsidy extension hopes dimmed post-shutdown

The government shutdown is gone, and so is much of the leverage Democrats had to pressure Republicans to extend enhanced subsidies for health insurance exchange plans.

While the seven Democrats and one allied independent who sided with the Republican majority to fund the government through Jan. 30 secured a promise from Senate Majority Leader John Thune (R-S.D.) to vote on the subsidies before year-end, too few GOP lawmakers have publicly come on board for a straight extension to pass.

Meanwhile, Republicans from President Donald Trump to rank-and-file members of Congress are hyping health policy proposals of their own that are unlikely to win over the Democratic minority. The 2026 open enrollment period for the health insurance exchange marketplaces began Nov. 1 and ends Jan. 15 in most states.

That doesn’t mean Democrats and outside advocates have given up on gaining Republican supporters.

“We just have to keep pushing them,” said House Energy and Commerce Committee ranking member Frank Pallone (D-N.J.).

“There are more people impacted by the loss of these subsidies — or tax credits — in their districts than there are in ours, and they have to be hearing the same thing I’m hearing,” Pallone said. “I just hope they wake up and realize that they better address this, and we’re just going to keep fighting until they do.”

House Democrats unveiled their latest bid last Wednesday with a bill to extend the enhanced tax credits for three years. Democrats employed a procedural tool called a “discharge petition” that enables legislation to come to the floor without the support of the majority party leadership.

However, discharge petitions require a majority to sign on, and no Republicans have endorsed the gambit. The GOP has a 219-214 edge over Democrats in the lower chamber, so the minority would need to be united and attract four Republican votes.

Two House Republicans, Reps. Jeff Hurd (Colo.) and Don Bacon (Neb.), have offered a framework that would grant a two-year extension along with some modifications, including income caps and stepped-up fraud and eligibility screening. Insurers have warned that new policies at this late date would be difficult to accomplish in time for 2026.

Thune pledged a mid-December vote. While the Democrats and the independent who voted to reopen government, and some Republicans have discussed ideas similar to Hurd and Bacon’s, the bill that will get a vote has not been released yet, and will likely go through Senate Minority Leader Chuck Schumer (D-N.Y.).

Schumer may be more inclined to align with House Minority Leader Hakeem Jeffries (D-N.Y.) and seek a three-year renewal. That’s partly because a one-year extension may come too late to fully mitigate premium increases for 2026 and because a two-year bill would expire before the $1.1 trillion in Medicaid and exchange cuts from Trump’s tax bill take effect.

At the same time, Republicans have revived their efforts at a long-elusive alternative to the Affordable Care Act of 2010, which created the exchanges and the original subsidies that Congress and President Joe Biden temporarily made more generous in 2021.

Last week, House Speaker Mike Johnson (R-La.) said the GOP is “pulling together the best ideas that we can” to reduce premiums but he did not express support for enhanced subsidies.

Trump has renewed his attacks on “Obamacare” and outright rejected extending the enhanced exchange subsidies in a post on social media platform, Truth Social.

“THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF AMERICA LONG ENOUGH. THE PEOPLE WILL BE ALLOWED TO NEGOTIATE AND BUY THEIR OWN, MUCH BETTER, INSURANCE. POWER TO THE PEOPLE! Congress, do not waste your time and energy on anything else. This is the only way to have great Healthcare in America!!! GET IT DONE, NOW. President DJT,” Trump wrote Tuesday.

That would likely be accomplished through expanded health savings or flexible spending accounts, as some Republicans have already suggested, though Trump has not elaborated.

In another sign that Republicans are looking in a different direction from the enhanced subsidies, Senate Finance Committee Chair Mike Crapo (R-Idaho) scheduled a hearing Wednesday entitled “The Rising Cost of Health Care: Considering Meaningful Solutions for all Americans.”

Witnesses were expected to include influential opponents of the ACA such as the Paragon Institute President Brian Blase, who is a past adviser to Trump, and Douglas Holtz-Eakin, president of the right-leaning American Action Forum.