The Senate voted down dueling health proposals. Here's what's at stake
for Americans
[December 12, 2025]
By ALI SWENSON
NEW YORK (AP) — When senators voted on rival health bills Thursday, they
had two chances to address expiring COVID-era subsidies that will result
in millions of Americans saddled with higher insurance costs in the new
year.
But the Senate rejected both, and hopes of solving the problem this year
are running dry. Affordable Care Act subsidies will end in three weeks,
more than doubling the premiums for many with health coverage through
the 2010 law known as “Obamacare.”
Meanwhile, the political stakes of rising premiums are looming as
affordability concerns have emerged as a key issue for American voters
going into the midterms next year.
Here's a look at the subsidies in limbo, the proposals to address the
problem and how American voters are feeling about the issue.
The Affordable Care Act subsidies brought down costs
More than 24 million people have health insurance through the ACA. That
includes farmers, ranchers, small-business owners and other
self-employed people without other health insurance options through
their work.
Enrollees who make less than 400% of the federal poverty level qualify
for permanent subsidies in the program that help them offset premium
costs.
In 2021, Democrats in Congress added additional subsidies, known as
enhanced premium tax credits, that apply to enrollees regardless of
their income. Those COVID-era subsidies are the ones set to expire Jan.
1.
With the expanded subsidies, some lower-income enrollees received health
care with no premiums, and high earners paid no more than 8.5% of their
income. Eligibility for middle-class earners was also expanded.
Health costs will rise for millions without a subsidy extension
If the tax credits expire, the average subsidized enrollee will see
their annual premium payments go up by 114%, from an average of $888 in
2025 to $1,904 in 2026, according to the health care research nonprofit
KFF.
Especially hard-hit groups will include a small number of higher earners
who will have to pay a lot more without the extra subsidies and a large
number of lower earners who will have to pay a small amount more, said
Cynthia Cox, a vice president and director of the ACA program at KFF.
Some enrollees, especially those who are young and healthy, may drop out
of coverage entirely rather than pay the steeper fees, experts say. A
recent KFF poll found that 1 in 4 enrollees said they would “very
likely” go without health insurance if their premiums doubled next year.
Others might opt for ACA plans with cheaper premiums that have worse
coverage and higher deductibles.
In most states, for Americans who want coverage to start Jan. 1, the
window to shop for ACA coverage began Nov. 1 and ends Monday.
Democrats backed an extension, while Republicans pushed for savings
accounts
The plan championed by Senate Democratic leader Chuck Schumer of New
York would have allowed the vast majority of program enrollees to keep
benefiting from the enhanced subsidies for three more years. It would
have saved millions of people money in the short term and allowed some
who might otherwise consider skipping coverage to stay insured.
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Sen. Mike Crapo, R-Idaho, left, and Sen. Bill Cassidy, R-La., emerge
from a GOP meeting at the Capitol in Washington, Jan. 28, 2020. (AP
Photo/J. Scott Applewhite, file)
 But that would have come at a cost
of nearly $83 billion added to federal deficits over the next decade
according to the Congressional Budget Office.
Republicans on Thursday backed a proposal from Sens. Bill Cassidy,
R-La., and Mike Crapo, R-Idaho, to scrap the subsidies in favor of
health savings accounts that would be funded for the next two years.
To be eligible, people would have had to choose a lower-cost, higher
deductible bronze or catastrophic health insurance plan and make
less than 700% of the federal poverty level. Those aged 18 to 49
would have gotten $1,000 a year, while those 50 and up would get
$1,500.
The money could have been spent on health costs but not premiums.
Health analysts warned that could have posed a problem when
low-income Americans were already struggling to afford monthly fees.
On Thursday, neither bill came close to the 60 votes needed to pass.
The political stakes are only growing
The impasse in the Senate came as lawmakers grow anxious about the
2026 midterms. Pocketbook concerns, including health costs, are
expected to be top issues for voters.
Democrats, who forced a 43-day shutdown over the expiring subsidies
earlier this fall, are sure to shine a spotlight on the subject.
Republicans may note that the Democrats in charge made the enhanced
subsidies temporary in the first place.
At the same time, the GOP has yet to unite on a path forward. In the
House, moderate Republicans who are up for reelection have been
pushing Speaker Mike Johnson, R-La., to extend the subsidies with
new reforms while the right flank of the party has demanded deeper
changes to a heath program they have long disliked.
Last month, the White House circulated a plan to extend the
subsidies for two years while adjusting eligibility requirements. It
ran into Republican pushback and has not had much traction since.
Trump, in a speech Wednesday, seemed to advocate an entirely
different plan, giving people money to buy their own health
insurance plans. Sen. Rick Scott, R-Fla., has introduced such a
bill.
House Majority Leader Steve Scalise, R-La., said some options could
be brought to the floor as soon as next week.
___
Associated Press writer Joey Cappelletti in Washington contributed
to this report.
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