Senate health bills fail as exchange subsidy expiration nears

The Senate failed to adopt either of a pair of healthcare cost bills Thursday, all but ensuring that the enhanced subsidies for health insurance exchange plans will disappear as scheduled in 21 days.

The Republican majority presented legislation that would not have renewed the subsidies but would have offered deposits into health savings accounts for people with high-deductible plans. Democrats pitched a three-year extension of the enhanced subsidies in place since 2021.

The Senate voted 51-48 on both measures, giving them a majorities but not the 60 supporters needed to avert filibusters and clear the way for votes on the underlying bills. House Republicans plan to consider healthcare legislation next week that may not include provisions to extend the enhanced subsidies.

Unless the Republican majority and President Donald Trump change course swiftly, health insurance exchange customers will pay on average more than twice as much after subsidies for their coverage next year, according to an analysis by the health policy research institution KFF. The 2026 open enrollment period began Nov. 1 and ends Jan. 15 in most states.

The legislative fight over the subsidies may be winding down but the political battle over this issue, and the more than $1 trillion in healthcare cuts Trump enacted in his tax law, will continue into next year’s midterm congressional elections.

Democrats continue to hound the GOP over the premium increases and coverage losses while Republicans blame the Affordable Care Act of 2010 itself for the rate spikes enrollees will endure.

“They think that a three-year extension with no reforms to try and disguise the real impact of Obamacare’s spiraling costs is actually a plan,” Senate Majority Leader John Thune (R-S.D.) said before the votes. “Democrats may talk about helping Americans, but their bill is nothing more than a political messaging exercise that they hope they can use against Republicans next November.”

Senate Majority Leader Chuck Schumer (D-N.Y.) emphasized that the Republican majority knew the subsidies would expire and never backed any kind of extension nor engaged with the minority party on a potential compromise.

“Our bill is the last train to leave the station,” Schumer said ahead of the votes. “After this, we will not have time to try again before premiums shoot through the roof.”

House Speaker Mike Johnson (R-La.) has not revealed what the lower chamber will debate next week, and a cohort of House Republicans has endorsed some form of subsidy extension, including bipartisan proposals that would pair the renewal with income caps and other modifications.

Yet opposition to the ACA and the enhanced subsidies remains strong among House Republicans, many of whom have expressed support for alternatives such as an HSA expansion.

Some House Republicans who represent swing districts have teamed up with Democratic allies on a last-ditch attempt to force a subsidy extension vote. These lawmakers aim to utilize what’s known as a discharge petition, which requires endorsements from a majority of lawmakers and enables Congress to consider legislation against the wishes of the majority party leadership.

Succeeding on this long shot would entail attracting support from disparate camps ranging from conservative Republicans to progressive Democrats in both chambers. Moreover, new bills must wait 30 legislative days before a discharge petition can trigger a vote.