As the clock ticks toward the end of 2025, Congress is locked in a fierce debate over the future of health insurance premiums for millions of Americans. With the Affordable Care Act (ACA) premium tax credits set to expire on December 31, more than 20 million people could face staggering increases in their health insurance costs unless lawmakers find a solution. The stakes? Sky-high premiums, political fallout, and a scramble for legislative fixes that so far have only deepened partisan divides.
On Thursday, December 11, Senate Republicans are set to vote on a GOP-crafted proposal aimed at addressing rising health insurance premiums. According to The Hill, Senate Majority Leader John Thune (R-S.D.) made the announcement after a tense GOP lunch meeting earlier in the week. The plan, drafted by Senate Health, Education, Labor and Pensions Committee Chair Bill Cassidy (R-La.) and Senate Finance Committee Chair Mike Crapo (R-Idaho), would convert the enhanced health insurance premium subsidies—originally enacted during the COVID-19 pandemic—into direct contributions to health savings accounts (HSAs).
Thune told reporters, “It actually does make health insurance premiums more affordable. It drives down, according to the Congressional Budget Office, premiums by double-digit levels.” But even as Thune touts the potential savings, there’s no guarantee the plan will pass. Deep divisions within the Republican conference have surfaced, with some senators favoring alternative approaches, such as temporary extensions of the ACA tax credits, and others pushing for more sweeping reforms.
Senators Susan Collins (Maine) and Dan Sullivan (Alaska), both facing tough re-election battles in 2026, have pressed for a vote on a Republican alternative to the Democratic bill that would extend the enhanced subsidies for three years. Collins argued, “I want to get something done for the people who are affected who are low- or middle-income families,” emphasizing the need for a viable GOP plan.
Yet, not all Republicans are on board with the Cassidy-Crapo proposal. Senator Rand Paul (R-Ky.) dismissed the plan as “a slight improvement,” adding, “It’s still a vote for Obamacare—something conservatives would have firmly rejected not long ago. I still support fully repealing Obamacare and replacing it with real free-market reforms.” Meanwhile, Senators Bernie Moreno (R-Ohio) and Jon Husted (R-Ohio) have floated their own alternatives, including a two-year extension of the ACA tax credits with new income limits and minimum premium requirements.
On the other side of the aisle, Democrats are pushing hard for a straightforward three-year extension of the ACA premium tax credits. Senate Minority Leader Chuck Schumer (D-N.Y.) has called the GOP bill a “phony proposal” and a “nonstarter,” arguing that it would promote “junk insurance” and raise costs for those who need care most. “It is junk insurance that puts the burden on people. We should call it what it is: misdirection, smoke and mirrors to cover up blocking the ACA tax credits that keep health care costs down,” Schumer said, according to Politico.
Experts outside Congress have also weighed in with skepticism. Sabrina Corlette, a Georgetown professor specializing in health care policy, told Politico that the Republican bill is “offering people a 1-foot rope to get out of a 10-foot hole.” She pointed out that the average deductible for a bronze plan is $7,500, double that for a family plan, and that the proposed HSA contributions—$1,000 per year for adults under 50 and $1,500 for those aged 50 to 64—would not go far enough, especially since children under 18 are excluded from the benefit.
House Republicans, meanwhile, are racing to assemble their own health care package as the December 31 deadline looms. According to Tipp Insights, House Majority Leader Steve Scalise (R-La.) acknowledged that Republicans remain divided on major elements and that negotiations will likely continue into 2026. While GOP leaders plan to vote next week on several bills aimed at lowering insurance costs, they have not committed to extending the tax credits themselves. Instead, House leaders are pushing for reforms such as income limits and anti-fraud measures, rejecting any “clean” renewal of the ACA credits.
The Democrats’ proposal, which would extend the ACA premium tax credits for three years, faces an uphill battle in the Senate, where it is expected to fall short of the 60 votes needed to advance. Both the Cassidy-Crapo plan and the Democratic bill are predicted to meet the same fate, potentially setting the stage for bipartisan negotiations through the holiday season and into the new year.
Moderates in both parties are exploring compromise options, including one- or multi-year extensions with income caps and new premium requirements. Some lawmakers are even considering using discharge petitions to force votes if congressional leadership stalls, a rare but potent procedural move that underscores the urgency of the crisis.
The political pressure is palpable, especially for Republicans in swing states. Senator Josh Hawley (R-Mo.) warned, “I just don’t know how Republicans would explain that to 24 million Americans whose premiums are going to double. People at home are going to say, 'You are hurting me. You’re making my premiums go up. You’re not helping me. Why are you doing that to me?'” Hawley’s warning echoes concerns from constituents like those shared by Senator Thom Tillis (R-N.C.), who relayed a story of a family facing their health insurance costs doubling from $800 to $1,600 a month.
Former President Donald Trump, asked about the Cassidy-Crapo bill, stopped short of a full endorsement but expressed support for the concept of “money going directly to the people, not to the insurance companies.” He added, “It can be in the health savings account, it can be a number of different ways.”
Yet, the GOP’s approach is not without critics from within its own ranks. Senator Lisa Murkowski (R-Alaska) expressed doubts that the Cassidy-Crapo alternative could garner the necessary 60 votes, saying, “It doesn’t deal with premiums and it doesn’t deal with the extension [of the subsidies], which is the current crisis.” Others, like Senator Lindsey Graham (R-S.C.), have shown little interest in extending ACA funding, arguing for broader system changes to address drug prices and overall health care costs.
Health policy experts, such as Larry Levitt of KFF, warn that the GOP proposal would benefit healthier people while leaving sicker enrollees facing steep out-of-pocket costs. “ACA enrollees who are sick would be stuck with big out-of-pocket premium increases or have to switch to a plan with a deductible of over $7,000. People with substantial health needs would blow through their modest health savings accounts and face big, out-of-pocket costs,” Levitt explained.
With both major proposals expected to fail in the Senate this week, uncertainty reigns. Lawmakers on both sides acknowledge that, barring a last-minute breakthrough, premium hikes are likely to go into effect, impacting millions. As the debate drags on, Americans watching their budgets anxiously are left to wonder: will Congress find common ground, or will partisan gridlock push health care costs even higher in the new year?
The coming weeks will test not just the legislative skill of Congress, but its willingness to prioritize the needs of Americans caught in the crossfire of policy and politics.
