With the clock ticking down to the end of the year, the U.S. Senate is facing a pivotal moment in the ongoing debate over health care affordability. On December 3, 2025, the Senate Health, Education, Labor and Pensions (HELP) Committee convened for a hearing that, against the odds, revealed a faint but real hope for bipartisan action to extend expiring Affordable Care Act (ACA) premium tax credits. These enhanced credits, which currently subsidize insurance costs for about one-third of marketplace enrollees, are set to expire on December 31, 2025—a deadline that looms large for millions of Americans.
Senator Bill Cassidy, a Republican from Louisiana and chair of the HELP Committee, set the tone for the day. "I'm hoping that we can find a bill that can get 60 votes that can fix the problem of the exchanges for January 1, 2026," Cassidy said, as reported by Roll Call and MedPage Today. He acknowledged the political reality: "It shouldn't be a Republican solution. It shouldn't be a Democratic solution. It should be an American solution." Cassidy was blunt about the impossibility of a sweeping overhaul with so little time left, but he urged colleagues to find a practical fix before the year’s end.
The urgency is palpable. If Congress does not act, families who rely on these subsidies will face what Senator Patty Murray (D-Wash.) described as "the mega healthcare hike," with premiums potentially doubling or even tripling in 2026. Open enrollment on the ACA exchanges closes December 15, leaving lawmakers just days to act. "We have 12 days," Senator Tammy Baldwin (D-Wisc.) reminded her colleagues. "The solution is not to let these enhanced tax credits expire. We've got to buy ourselves time to do these larger reforms."
While most Senate Republicans have signaled opposition to extending the tax credits, a handful at the hearing voiced a willingness to consider a temporary extension—albeit with caveats. Senator Jon Husted (R-Ohio) suggested, "We can freeze the subsidies where they're at right now for a temporary period of time— I don't know if that's 1 year, 2 years—to help give some relief. It's a little help right now that we both can agree on, and then we've got to fix [the system]."
Senator Lisa Murkowski (R-Alaska) echoed the need for a short-term solution, but also called for "reasonable caps" on subsidies while longer-term reforms are developed. She added, "If we fail to do something relatively soon here, the consequences are severe to people." Senator Susan Collins (R-Maine) zeroed in on the lack of an income cap for the enhanced credits, noting, "There is no income cap on the enhanced premium tax credits. That means, according to our calculations, that a family of four living in Augusta, Maine, making $325,000 a year ... qualify for a taxpayer-funded subsidy."
Joel White, president of the Council for Affordable Health Coverage and a witness at the hearing, agreed with Collins. "Absolutely yes," he said when asked if an income cap was needed. "We need to understand that those subsidies above 400% of poverty are financed in part by taxes on working Americans ... So there needs to be some kind of recognition that we can't tax low-income people to pay for high-income people's subsidies."
Some Democrats, too, are open to tweaking the structure of the credits. Senator Maggie Hassan (D-N.H.) said, "In my own view, this means we do have to do a short-term extension, straight up. There are a couple of reforms on the enhanced subsidies that I think there’s some bipartisan agreement we might be able to get to. But we need to do that right now and then think about what’s next in terms of overall cost reduction."
But not all Democrats are convinced. Senator Patty Murray (D-Wash.) cautioned, "Even if we passed a bill today, there is not time to implement anything more complicated than a clean extension." She added, "So if Republicans are serious about preventing the mega healthcare hike, they should work with us right now to pass a clean 1-year extension as fast as possible."
Senator Bernie Sanders (I-Vt.), ranking member of the committee, took a broader view. "Let us extend the current ACA tax credits for at least another year, 2 years, 3 years, while in this committee, we tackle the real issues," Sanders urged. He called for a panel to study how other nations provide universal health care, arguing, "We are the only major country on Earth that does not do that. In my view, the answer is going to be to emulate what many other countries do, guarantee healthcare to all people [by implementing] Medicare for all." Sanders was also quick to reject Cassidy's proposal to replace subsidies with health savings accounts (HSAs), insisting, "Your program is not going to guarantee health insurance for all people. We will not accept that, will not accept the doubling of premiums."
The HSA idea, floated by Cassidy, would redirect funds currently used for tax credits into accounts that enrollees could use for medical expenses. However, as several Democrats pointed out, current law does not allow HSA funds to be used for premium payments—a major sticking point. Marcie Strouse, a benefits consultant and witness, suggested, "HSAs should be modernized so families can save more, use funds to pay for small-group premiums, and treat HSAs as true long-term health investment tools." Cassidy indicated some flexibility, saying he would be "open" to a plan that gives eligible individuals the option to take a subsidy as either a premium reduction or as an HSA contribution.
Beyond the immediate subsidy crisis, senators discussed other bipartisan reforms. Senator Tim Kaine (D-Va.) highlighted past bipartisan efforts to reform pharmacy benefit managers (PBMs), which he criticized for skewing the drug market and inflating costs. "I don't like pharmacy benefit managers who don't do any medical research, who don't produce any products," Kaine said. "I don't like them charging based on a percentage of the drugs that they're sending out, which gives them an incentive to ... skew the market toward higher-cost drugs."
Senator Roger Marshall (R-Kansas) promoted his Patients Deserve Price Tags Act, designed to increase price transparency in health care. "Americans are great shoppers if you give them the opportunity to look at price tags," Marshall argued, claiming the bill could save $1 trillion per year. During the hearing, Senators Lisa Blunt Rochester (D-Del.) and John Hickenlooper (D-Colo.) both announced their support for the bill, with Hickenlooper emphasizing the importance of price transparency for large employers and consumers alike.
Looking ahead, Senator Lisa Blunt Rochester said she plans to introduce legislation on December 4, 2025, to extend the credits for three years, reduce barriers to enrollment, and increase transparency from insurers. As the deadline approaches, the Senate faces three options, as Cassidy outlined: let the credits lapse, hold separate partisan votes destined to fail, or work together for a bipartisan solution.
With the stakes high and time short, the Senate’s next steps will determine whether millions of Americans face a steep rise in health care costs in the new year—or whether lawmakers can bridge the partisan divide, at least for now.
