On December 11, 2025, the U.S. Senate delivered a dramatic blow to millions of Americans relying on Affordable Care Act (ACA) subsidies, voting down dueling health insurance measures that would have extended or replaced the enhanced premium tax credits set to expire at year’s end. The legislative deadlock, which played out along sharp partisan lines with a handful of notable defections, leaves about 24 million Americans bracing for significant increases in health insurance premiums starting January 1, 2026, according to Reuters.
The stakes are especially high in Wyoming. There, a 60-year-old earning roughly $63,000 will face a staggering 421% increase in average monthly ACA marketplace premiums, the highest jump in the nation, as reported by WyoFile. Other western states aren’t far behind: Montana, Colorado, Utah, and Idaho are all seeing triple-digit percentage increases, but none as severe as Wyoming’s. While not all of the state’s 45,000 ACA customers will experience such dramatic hikes—since costs still depend on age and income—the looming sticker shock is expected to push many to seek cheaper, less comprehensive private plans or drop coverage altogether, raising the specter of higher uncompensated care costs for hospitals and even insured patients.
How did it come to this? The ACA, passed in 2010, created a marketplace for those not eligible for Medicaid or employer-based insurance. In the thick of the COVID-19 pandemic, Congress enacted the Enhanced Premium Tax Credit in 2020, slashing monthly premiums for millions and, in some cases, reducing them to zero for low-income Americans. The program was extended in 2022, but with fiscal hawks warning of ballooning deficits, Congress let the enhanced credits lapse this year. According to the Congressional Budget Office, extending the credits would cost $83 billion over ten years—a price too steep for many Republicans, who argue the subsidies merely prop up a flawed system.
The Senate showdown featured two starkly different visions. Democrats pushed the Lower Health Care Costs Act, which would have extended the enhanced subsidies for three years, hoping to stave off what they call a “life and death” crisis for Americans facing unaffordable coverage. “This is not a symbolic vote. This is a life and death vote, because people who will lose their health care could face that horrible, horrible end,” said Democratic Sen. Chuck Schumer of New York on the Senate floor, as quoted by WyoFile. Schumer also accused Republicans of being divided, noting, “Democrats are fighting to lower the health care costs for the American people, while Republicans are fighting among themselves.”
Still, the Democratic proposal fell short of the 60 votes needed to overcome a filibuster. Four Republican senators—Josh Hawley of Missouri, Dan Sullivan of Alaska, Lisa Murkowski of Alaska, and Susan Collins of Maine—broke ranks to support the extension, as CBS News and Reuters both reported. But the majority of Republicans, including Wyoming’s senators John Barrasso and Cynthia Lummis, voted against it. Barrasso, a retired doctor and Senate Majority Whip, was particularly vocal, lambasting the ACA as an unsustainable “disaster.” On the Senate floor, he declared, “What [the Democrats] are proposing isn’t a serious plan. It’s a disaster. Our nation can’t afford it. The American people can’t afford to pay these high costs for health care. We need to focus on the cost of care.”
The Republican alternative, authored by Sens. Bill Cassidy of Louisiana and Mike Crapo of Idaho, would have replaced the enhanced tax credits with Health Savings Account (HSA) contributions and provided up to $1,500 to individuals earning less than 700% of the federal poverty level—roughly $110,000 for an individual or $225,000 for a family of four. The funds could not be used for abortion or gender transition procedures and would require verification of immigration or citizenship status, provisions Democrats flatly rejected. No Democrats supported the Republican plan, which was dismissed by Schumer as a “political messaging exercise.”
Republican leaders, for their part, argued that the Democratic plan was fiscally reckless and failed to address deeper flaws in the ACA. House Speaker Mike Johnson called the subsidies a way to “subsidize the broken system … that is riddled with fraud.” Sen. John Boozman of Arkansas echoed this sentiment on social media, writing, “Taxpayer-funded premium subsidies go directly to insurance companies and prop up proven examples of waste, fraud and abuse. Yet Democrats are insisting on no reforms while throwing more money at the failing system they created, without a single Republican vote.”
Concerns about fraud in the subsidy system were amplified by a recent Government Accountability Office (GAO) report, which found systemic fraud risk in the enhanced subsidies. According to the GAO, more than 90% of its fake applicants received coverage, and agents and brokers had financial incentives to maximize enrollments under the current tax credit system.
President Donald Trump, who has largely stayed out of the public fray over healthcare this session, ultimately threw his support behind the Republican approach. At the Congressional Ball on Thursday, he argued, “We have an idea that rather than making these massive payments … [to] insurance companies, we make beautiful big payments directly to the people, and they buy their own.” But even the $1,500 payments in the Republican bill fell well short of the typical deductibles for lower-cost ACA plans, which can run up to $7,500. As Reuters noted, a single emergency room visit or ambulance ride could wipe out the benefit in one go.
With Congress set to begin its holiday recess the week of December 16, 2025, and the House of Representatives yet to unveil a possible rescue bill, the window for a last-minute compromise is rapidly closing. Even if the House manages to pass a measure, it faces daunting odds in the Senate, where partisan lines have hardened. Moderate Republican Rep. Brian Fitzpatrick of Pennsylvania is trying to rally bipartisan support for a subsidy extension through 2027, but there’s no guarantee of success.
The public, meanwhile, is watching closely. A Reuters/Ipsos poll found that 51% of Americans—three-quarters of Democrats and a third of Republicans—support extending the subsidies, with only 21% opposed. The percentage of returning customers in the Obamacare exchanges has dipped slightly, with only 19.9% of enrollees opting to renew their plans so far, compared to 20.5% this time last year, as Reuters reported. Insurance companies have already warned customers about the coming premium hikes, and health care advocates are urging consumers to carefully review their options before the enrollment deadline.
For those hoping to secure ACA coverage starting January 1, 2026, the deadline to enroll is December 15, 2025. A late enrollment period runs until January 15, 2026, for coverage beginning February 1. In Wyoming, the situation is further complicated by the departure of Mountain Health Co-op, leaving only two providers in the state. Navigators advise consumers to avoid letting policies auto-renew and to be wary of private plans that seem too good to be true.
With the 2026 midterm elections on the horizon, the political stakes are high. Many Republicans are anxious about the fallout from steep premium increases, especially in states that backed Trump in 2024. As Sen. Josh Hawley of Missouri put it, “We can’t afford our premiums now, let alone if they would go up by 50 or 100%.”
As the dust settles, Americans are left with more questions than answers—and a pressing need to brace for higher healthcare costs in the new year.
