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The Senate on Thursday rejected competing health care bills from both parties, leaving Congress with little time to prevent steep premium increases for millions of Americans set to take effect early next year.
Neither measure reached the 60-vote threshold needed to advance, increasing the likelihood that enhanced Affordable Care Act subsidies enacted in 2021 will expire at year’s end. Without an extension, premiums are projected to double on average for roughly 22 million people who rely on the additional federal assistance.
Democrats say the looming increases hand them a potent political issue heading into the 2026 midterm elections if Congress fails to act.
“The Republican plan is a ‘when you get sick, you go broke’ plan,” Senate Minority Leader Chuck Schumer, D-N.Y., said on the Senate floor.
The Democratic bill would have extended the enhanced subsidies for three more years. It failed, 51–48, though four Republicans — Sens. Susan Collins of Maine, Josh Hawley of Missouri, and Alaska’s Lisa Murkowski and Dan Sullivan — joined Democrats in supporting it.
“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 John Thune, R-S.D., said.
Republicans countered with their own measure to let the ACA funding expire while expanding access to tax-advantaged health savings accounts and broadening the availability of lower-cost “bronze” and “catastrophic” marketplace plans. The proposal, authored by Sens. Mike Crapo, R-Idaho, and Bill Cassidy, R-La., also failed, 51–48, with Sen. Rand Paul, R-Ky., joining Democrats in voting no. Sen. Steve Daines, R-Mont., missed both votes.
Thune argued the GOP bill would “deliver the benefit directly to the patient, not the insurance company,” while reducing government spending. “That is a win-win proposal,” he said.
President Donald Trump said he supports the “concept” of the Crapo-Cassidy plan but has not endorsed it outright and has not proposed an alternative of his own.
Democrats sharply criticized the GOP approach, saying the expanded HSA options would offer too little help for people facing high out-of-pocket costs.
“Under the Republican plan, the big idea is essentially to hand people about $80 a month and wish them good luck,” Schumer said, arguing that many of the plans available at those contribution levels carry deductibles over $7,000. “How ridiculous. How stingy. And how mean and cruel to the American people.”
Even some Republicans acknowledged the party’s bill did not address the central problem of rising premiums.
“I think giving people more money to pay for their deductible is a great idea,” Hawley said. “I think we probably still need to do something on premiums, because you can’t use the HSAs on premiums.”
Sen. Jeanne Shaheen, D-N.H., said she believes another opportunity to extend the ACA subsidies may emerge in January if lawmakers fail to reach agreement before the holidays.
House Republican leaders have said they hope to bring a health care plan to the floor next week, but the party has not yet coalesced around a proposal, and no vote has been scheduled. Some swing-district Republicans have signed on to two discharge petitions aimed at bypassing Speaker Mike Johnson, R-La., and forcing votes on extending the ACA money.
Many Republicans in both chambers support allowing the enhanced subsidies to end on schedule. Congress is slated to adjourn next week, leaving little time to bridge the divide.
