As the clock ticks down to the expiration of enhanced Affordable Care Act (ACA) premium tax credits on December 31, 2025, Congress finds itself embroiled in a heated and often bewildering debate over the future of healthcare policy in the United States. The past week’s flurry of legislative activity has exposed deep divisions within the Republican Party and set the stage for a potential showdown when lawmakers return from their holiday recess in early January 2026.
Representative Brian Fitzpatrick (R-PA), a moderate voice in the GOP, has emerged as a prominent critic of his own party’s approach to healthcare reform. In a candid interview with CNN’s Manu Raju, Fitzpatrick did not mince words about what he sees as the party’s failure to present a viable alternative to the ACA subsidies that millions of Americans rely on for affordable health coverage. “If you don’t have a better plan, then get on board with ours. But doing nothing is not an option, right?” Fitzpatrick stated, underscoring the urgency as the year’s end approaches and the stakes rise for families across the country (CNN).
Fitzpatrick’s frustration isn’t new. He reflected on the GOP’s previous attempts to repeal the ACA, recalling his own vote against repeal efforts because the proposed replacement was, in his words, “insufficient” and “hastily put together.” Now, eight years later, he laments, “They still have not been able to put together an articulable plan that’s going to work for everyday Americans.” His criticism goes beyond policy proposals; Fitzpatrick has also taken aim at what he describes as misplaced House priorities. “Affordability should be the name of the game. Every bill. Every bill we bring to the floor should be focused on lowering the cost of living for people who need it most,” he told CNN, expressing exasperation at time spent on symbolic measures rather than substantive reforms.
This internal dissent comes as House Republican leadership, under Speaker Mike Johnson (R-LA), unveiled H.R. 6703, the Lower Health Care Premiums for All Americans Act. The legislation, which passed the House by a narrow 216–211 margin on December 19, 2025, notably does not extend the enhanced premium tax credits. Instead, it aims to expand association health plans for small businesses and the self-employed, codify and rename individual coverage health reimbursement arrangements as “custom health option and individual care expense arrangements” (CHOICE plans), preempt state restrictions on stop loss insurance, implement pharmacy benefit manager reforms, and permanently appropriate cost-sharing reduction payments—while explicitly prohibiting their use by plans covering abortions (Congressional Record).
Yet, the Congressional Budget Office found that H.R. 6703 would save $35.57 billion over ten years but increase the number of uninsured Americans by 100,000 annually. The bill’s passage was overshadowed by controversy when House leadership blocked amendments, including Fitzpatrick’s proposal to extend the enhanced ACA tax credits for two years with reforms, from coming to a floor vote. The move prompted Fitzpatrick and three other moderate Republicans—Reps. Mackenzie (PA), Lawler (NY), and Bresnahan (PA)—to break ranks and sign a Democratic-led discharge petition to force a vote on a clean three-year extension of the enhanced tax credits.
“The only policy that is worse than a clean three-year extension without any reforms, is a policy of complete expiration without any bridge. Unfortunately, it is House leadership themselves that have forced this outcome,” Fitzpatrick declared, highlighting the sense of urgency and disarray within GOP ranks (House floor remarks).
The discharge petition, which garnered the necessary 218 signatures, is subject to a procedural waiting period, meaning any vote on the extension will not occur until January 2026. Meanwhile, with the Senate having already rejected a clean three-year extension earlier in December, the prospects for a swift resolution remain uncertain. Lawmakers from both parties are reportedly working toward a compromise, hoping to craft a package that might be palatable to the Senate and avoid a lapse in coverage for millions come January 1, 2026.
Amid the healthcare wrangling, the House also passed two controversial bills concerning gender-affirming care. H.R. 3492, the Protect Children’s Innocence Act, would criminalize the provision of gender-affirming care to minors under 18, with penalties including fines and up to ten years in prison. H.R. 498, the Do No Harm in Medicaid Act, would prohibit federal Medicaid funding for such care. Both measures passed largely along party lines, though several lawmakers crossed the aisle in both directions. The fate of these bills in the Senate remains unclear, and their interaction with newly proposed rules from the Department of Health and Human Services (HHS) adds another layer of complexity.
HHS, for its part, has issued proposed rules that would limit federal Medicaid and Children’s Health Insurance Program funding for gender-affirming care for youth, restrict the performance of certain procedures on minors, and increase federal research on individuals who detransition. The agency declared that such procedures for children and adolescents fail to meet professionally recognized standards of care and are neither safe nor effective as treatment for gender dysphoria or related conditions in minors. Public comments on these rules are due in early 2026, setting up another front in the ongoing debate (HHS press release).
Beyond the high-profile battles over insurance subsidies and gender-affirming care, Congress and the administration have also tackled a host of other health policy issues. The House Energy and Commerce Oversight Subcommittee held hearings on biosecurity and artificial intelligence, with partisan disagreements over the preparedness of the Department of Health and Human Services for outbreaks like measles. The Joint Economic Committee discussed ways to improve healthcare outcomes and reduce costs, with Republicans focusing on insurance fraud and technology, and Democrats emphasizing the need to extend the enhanced ACA credits.
In the Senate, Finance Committee Ranking Member Ron Wyden (D-OR) introduced legislation to reform the organ transplantation system, aiming to strengthen federal oversight of organ procurement organizations. Meanwhile, the Centers for Medicare & Medicaid Services Innovation Center announced the LEAD Model, a 10-year accountable care initiative designed to increase participation among small, rural, independent, and safety-net providers, starting January 1, 2027. The HHS Office of the National Coordinator for Health Information Technology also issued a request for information on how best to support the adoption of artificial intelligence in clinical care.
As Congress heads into its holiday recess, the healthcare debate is far from settled. The Senate is scheduled to return on January 5, 2026, and the House on January 6, with a potential vote on the discharge petition looming. For millions of Americans who depend on the enhanced ACA tax credits, the coming weeks will be critical. Lawmakers face mounting pressure not only from their constituents but from within their own ranks to find a solution that ensures affordable coverage and addresses the evolving needs of the nation’s healthcare system.
With the landscape shifting rapidly and the stakes higher than ever, the next chapter in the healthcare saga is set to unfold in the new year—promising more debate, more drama, and, perhaps, long-overdue answers to questions that have lingered for nearly a decade.
