Collins, Moreno unveil 2‑year ACA subsidy plan as Senate nears Thursday vote on 3‑year extension
Sen. Susan Collins and Sen. Bernie Moreno unveiled a GOP proposal to extend enhanced ACA premium tax credits for two years with a $200,000 income cap and measures to end zero‑premium plans (including a $25 minimum monthly payment). The rollout comes as the Senate readies a Thursday vote on Democrats’ clean three‑year extension, setting up dueling proposals — including GOP HSA alternatives and contentious Hyde and verification riders — that face significant procedural and political hurdles.
📌 Key Facts
- Senate Democrats, led by Majority Leader Chuck Schumer, unveiled a clean, three‑year extension of the enhanced Affordable Care Act (ACA) premium tax credits and will bring that bill to a floor vote next Thursday (second week of December); Democrats say all caucus members will back it, but it is widely expected to fall short of the 60 votes needed to advance.
- Senators Susan Collins and Bernie Moreno unveiled a Republican two‑year alternative that would limit subsidy eligibility (income cap reported at $200,000), require a $25 minimum monthly premium (ending zero‑premium plans), add fraud‑prevention and verification guardrails, and is being pitched as a side‑by‑side option to the Democratic 3‑year plan.
- Republican negotiators are also advancing other alternatives — notably proposals to redirect subsidy dollars into pre‑funded Health Savings Accounts (HSAs) (led by Sens. Bill Cassidy, Rick Scott and others) and to attach policy riders (Hyde‑style abortion restrictions, Medicaid verification, limits on gender‑transition coverage) — but the GOP remains divided and has not coalesced around a single unified plan.
- Timing pressure is acute: open enrollment is underway with Jan. 1 effective dates looming, Senate leaders (John Thune) have promised a mid‑December vote, and uncertainty over whether the House will take up any Senate extension increases the risk of coverage disruption for millions if Congress fails to act promptly.
- Analyses from KFF and the Congressional Budget Office underscore the stakes: roughly 22–24 million marketplace enrollees would be affected, average premium payments for subsidized enrollees could more than double without the enhanced credits, and CBO has estimated several million could become uninsured if the subsidies lapse; polls show broad public support for renewing the enhancements.
- A central negotiating roadblock is Hyde‑style abortion‑funding language and related riders: Republican insistence on such provisions has repeatedly stalled bipartisan compromise and is a key reason Democratic leaders say many GOP alternatives are unacceptable.
- The White House and President Trump have signaled openness to alternatives (including converting subsidies into direct payments or HSAs) and urged GOP unity, while Democrats maintain a clean‑extension stance; negotiators on both sides continue talks but significant policy and political divisions leave the outcome uncertain.
📊 Relevant Data
Nearly 1.7 million undocumented immigrants are enrolled in Medi-Cal, California's Medicaid program, as of September 2025.
Medi-Cal Coverage for Undocumented Immigrants in California: What Will Happen to the Progress Made Over the Years? — Institute for Health Policy Leadership
Approximately 152,000 transgender adults are enrolled in Medicaid in the US, with fewer than half (69,000) living in states that cover transition-related care.
152000 transgender adults are enrolled in Medicaid — Williams Institute
In 2022, non-Hispanic Black women accounted for 39.5% of reported abortions while Black Americans make up about 13% of the US population; the abortion rate was 24.4 per 1,000 Black women aged 15–44 years, compared to 5.7 for White women (59% population), 11.6 for Hispanic women (19% population), and 9.4 for other non-Hispanic women.
CBO estimates that Medicaid spending on services for illegal immigrants cost federal and state taxpayers more than $16.2 billion under the Biden-Harris administration.
CBO: Medicaid Spending on Illegal Aliens Has Cost Taxpayers over $16.2 Billion Under Open Border Czar Harris — House Budget Committee
📊 Analysis & Commentary (15)
"A Republican opinion piece argues that House Democrats are weaponizing a government shutdown for progressive policy goals instead of supporting a GOP-passed clean continuing resolution to keep essential services open, urging Democrats to vote to avert the lapse."
"A political‑economy deep dive arguing the current shutdown is produced by three underlying contradictions — between policy goals and political incentives, between chamber rules and governance needs, and between public messaging and accountability — rather than by a single bill, and that both parties’ incentives make compromise unlikely unless the structural tensions are addressed."
"Karl Rove’s short opinion criticizes the Trump White House’s handling of the federal shutdown—highlighting contradictory messaging (Trump claiming talks while aides/Schumer deny them) and arguing the core problem is the president’s lack of focus and management."
"A critical opinion piece arguing Democrats repeatedly misplay shutdown fights—by prioritizing policy riders like ACA subsidy extensions over reopening the government—hurting vulnerable people and their own political standing."
"Nate Silver argues that despite a late October political opening created by Trump’s missteps (notably around SNAP) and favorable state election results, Senate Democrats inexplicably surrendered leverage by voting for cloture on the GOP appropriations bill—a strategic failure he attributes to risk‑averse leadership, poor messaging, and the political urgency of preventing SNAP cuts."
"Matthew Yglesias argues that the end of the shutdown — though publicly framed around SNAP and health‑care subsidies — was really a battle over Senate procedure (the filibuster/appropriations process), that political blame fell on Trump (benefiting Democrats), and that key senators blinked to preserve institutional norms rather than pressing for policy wins, a choice the author criticizes and links to broader debates over filibuster reform."
"A conservative Fox Opinion roundup commenting on the Senate's passage of the short‑term funding bill, using the shutdown vote as a springboard to criticize Democratic leadership (Schumer, Pelosi), promote GOP policy fixes (prison reform, veterans), and explain recent political dynamics in a pro‑Republican frame."
"The piece comments on the end of the record federal shutdown (which did not include ACA subsidy extensions) and argues — drawing on recent Democratic electoral wins — that Republicans may pay the political price for the shutdown despite Democrats’ policy setback."
"The piece critiques media framing that calls the Democrats who voted to end the shutdown 'moderates,' arguing that moderation should be defined by policy positions that align with public preferences and substantive centrism, not by tactical capitulation."
📰 Sources (170)
- Confirms the Thursday vote will include a GOP-backed HSA alternative endorsed by Thune and supported by a majority of Senate Republicans.
- Specifies additional GOP policy riders (Medicaid verification and funding limits, gender-transition coverage bans, Hyde provisions) that will be contrasted with Democrats’ clean three-year extension.
- Parallel to Senate action, House swing-district Republicans are backing a new bipartisan proposal with support from roughly 15 Republicans and 20 Democrats to extend the enhanced ACA credits.
- House dynamics include an October letter from 13 Republicans pressing Speaker Johnson for a temporary extension and his current lack of commitment to a pre–Jan. 1 vote.
- Sens. Susan Collins and Bernie Moreno unveiled a GOP plan to extend enhanced ACA premium tax credits for two years.
- The proposal adds an income cap, limiting subsidy eligibility to households earning up to $200,000.
- It would end zero-premium plans by requiring a $25 minimum monthly payment, framed as an anti-fraud measure.
- Article notes Republicans may seek a side-by-side vote while Democrats back a three-year Schumer plan likely to fail without GOP support.
- Includes fresh quotes from Collins and Moreno on avoiding coverage disruptions and lowering costs; reiterates Trump's preference to convert subsidies to HSAs.
- Sen. John Thune said the Democratic plan is 'obviously designed to fail.'
- Senate Republicans have not coalesced around their own proposal and may not before the chamber leaves Washington next week.
- Schumer argues the plan could pass with 13 Republican votes and says Republicans have 'chosen to do nothing.'
- Bipartisan talks since the shutdown have 'virtually ground to a halt.'
- Republicans cite lack of reforms, the three‑year length, and absence of Hyde‑style abortion language as reasons to oppose.
- An HSA‑based alternative is being pushed by Sen. Rick Scott and worked on by Sen. Bill Cassidy; the concept has been embraced by President Donald Trump.
- Sen. Peter Welch said compromise discussions were “aspirational” and never became concrete.
- Chuck Schumer pressed Republicans, saying “Thirteen votes could solve the problem… They can just vote for this, plain and simple.”
- The shutdown-ending deal promised an ACA subsidy vote in the second week of December after eight Senate Democrats joined Republicans to end the impasse.
- Republicans previously rejected a shorter, one-year extension during the shutdown and insisted on reopening government before negotiating; Hyde amendment restrictions remain a central sticking point.
- The Senate will vote Thursday on a Democratic proposal to extend enhanced ACA premium tax credits for three years.
- The Democratic plan is not expected to reach the 60 votes needed to advance.
- Senate Republicans remain divided, with some pushing income caps and eligibility‑limiting reforms.
- Sen. John Thune has promised Democrats a vote next week on their ACA subsidy bill; GOP responses are more likely via amendments or UC requests than a unified package.
- Sen. Susan Collins is circulating a plan to extend subsidies with a $200,000 income cap and to end zero-dollar premium plans.
- Sen. Roger Marshall wants to move expiring subsidies into HSAs and attach his bipartisan price-transparency bill; Republicans are also eyeing changes to cost-sharing reductions.
- Hyde-related abortion-funding assurances remain a sticking point in GOP talks.
- House Democrats filed a discharge petition for a clean three-year extension; no Republicans have signed.
- A bipartisan House group (35 centrists led by Reps. Jen Kiggans and Josh Gottheimer) unveiled a two-year extension Thursday, lacking leadership buy-in.
- Republicans are insisting Hyde Amendment abortion-funding restrictions apply to the ACA subsidy extension, creating a major roadblock to a bipartisan deal.
- Sen. John Thune called handling Hyde 'a big issue' and said both sides must figure out how to make it work.
- Sen. Mike Rounds said Democrats do not want the enhanced premium subsidies covered by Hyde language and reaffirmed GOP opposition to taxpayer-funded abortions.
- Talks among negotiators have largely stalled over the Hyde provisions, and Democrats’ clean three‑year extension is expected to fail next week.
- RSC Chair Rep. August Pfluger will file 'The More Affordable Care Act' to create 'Trump Health Freedom Accounts' (HSAs) funded by redirecting ACA premium subsidies in participating waiver states.
- States could opt out of major ACA provisions if they protect high‑risk pools, run their own exchanges or allow private exchange platforms, and enable cross‑state plan purchases among waiver states.
- Pfluger says the bill will be introduced Monday and expects 'significant interest' from House Republicans; unclear if it will be folded into the leadership’s broader health package.
- House bipartisan caucus unveiled a named alternative ('CommonGround 2025') to the Senate Democrats’ proposed clean 3‑year extension.
- The House plan seeks a one‑year extension with targeted reforms and fraud guardrails and asks both chambers to vote by Dec. 18.
- A letter from 35 House members to leaders in both chambers formally requests consideration.
- Schumer said on the Senate floor that every single Democrat will support a clean three-year extension of ACA premium tax credits.
- He confirmed Democrats will bring their bill to the floor next Thursday under the shutdown-reopening agreement that guaranteed a vote.
- Thune told CBS News Republicans are still working with members and "will have a plan," signaling a potential GOP alternative alongside the Democratic bill.
- Republicans previously rejected a clean extension offer near the end of the shutdown, per the CBS report.
- Schumer announced Senate Democrats will introduce a 'clean, three-year' extension of enhanced ACA premium tax credits and said all Democrats will support it.
- Senate vote on the proposal is planned for next Thursday, expected by Dec. 11; Majority Leader John Thune agreed to bring a proposal to the floor.
- Republican working draft led by Sens. Bill Cassidy and Mike Crapo focuses on routing subsidy dollars into Health Savings Accounts (HSAs) instead of insurers; no unified GOP strategy yet.
- Republicans continue to demand reforms including income caps and Hyde-style abortion-funding restrictions; Democrats largely prefer a clean extension.
- KFF survey of 1,300+ ACA marketplace enrollees (fielded in early November) finds most expect their health costs to be impacted next year if enhanced subsidies expire and overwhelmingly support an extension.
- KFF analysis cited in the piece estimates the average subsidized enrollee’s monthly payment would more than double without the enhanced credits.
- About 6 in 10 enrollees say out-of-pocket costs are somewhat or very difficult to afford; roughly half say premiums are difficult to afford, and most say they cannot absorb a $300/year increase without significant household disruption.
- Surveyed enrollees are more likely to blame President Trump and Republicans in Congress than Democrats if the tax credits lapse.
- Open enrollment is underway with less than a month before the enhanced subsidies expire, while no consensus plan has emerged in the House.
- Senate will hold a vote next week on Affordable Care Act enhanced tax credits; Democrats can present legislation of their choice for that vote.
- Majority Leader John Thune says there is no clear path yet and identifies Hyde amendment applicability to ACA policies as the biggest obstacle.
- Minority Leader Chuck Schumer says Republicans' push to expand Hyde blocks broader talks on lowering costs.
- Sen. Chris Murphy says he prefers a clean multi-year extension but is open to a one-year extension with income restrictions to reach 60 votes.
- Thune says GOP had a 'robust discussion' at conference lunch but no breakthrough; Republicans are still trying to coalesce around a strategy.
- Senate Majority Leader John Thune says he will still hold a vote next week even if bipartisan negotiations are not ready.
- Republicans are coalescing around a proposal to route ACA subsidy funds into pre-funded Health Savings Accounts (HSAs) rather than to insurers.
- Sen. Bill Cassidy is leading the GOP effort and described an HSA framework that could include about $2,000 in pre-funding per enrollee.
- Sen. Roger Marshall says a bipartisan deal is unlikely by next week and is instead targeting Jan. 30 for a broader package; Sen. Tammy Baldwin voiced skepticism about a side-by-side vote approach.
- Draft White House plan would extend ACA subsidies for two years.
- Eligibility would be capped at 700% of the federal poverty level, according to two people familiar with the proposal.
- All marketplace enrollees would be required to pay some premium, effectively ending zero-premium plans.
- Sen. Thom Tillis publicly urged addressing subsidies in December and warned of political fallout if not fixed.
- Sen. Jeanne Shaheen signaled openness to elements of the reported plan; Rep. Mike Flood’s Main Street Caucus voiced support for addressing the tax-credit cliff.
- It remains unclear when or whether the White House will formally release the proposal; GOP divisions persist.
- Despite a shutdown-ending commitment to hold a vote within a month on enhanced ACA tax credits, Johnson told the White House most House Republicans aren’t interested in an extension.
- The White House had been preparing a two-year extension plan expected to emerge this week.
- The spending bill includes a provision curbing the sale of intoxicating hemp‑derived THC products (e.g., Delta‑8) and, per Senate Appropriations, preserves non‑intoxicating CBD and industrial hemp products.
- There is a one‑year implementation delay before enforcement (into late 2026) to allow USDA, FDA and states to update rules.
- Sen. Rand Paul attempted to strip the THC language but failed; 39 state attorneys general urged Congress to outlaw intoxicating hemp products.
- The CR includes carveouts that fund SNAP, WIC, the Department of Veterans Affairs and Congress through September 2026.
- The package provides increased security funding for members of Congress, executive branch officials, federal judges and Supreme Court justices.
- Shutdown length confirmed at 43 days; NPR reiterates roughly 42 million SNAP recipients and more than 3 million federal workers were affected.
- Finance Committee set to hold a public hearing on health costs Nov. 19 to advance ACA subsidy discussions.
- Emerging bipartisan contours: GOP insists on a short-term extension with reforms, including an income cap and anti-fraud premium design.
- Heightened risk of House inaction and need for Trump’s signoff despite mixed public messaging on the ACA.
+ 150 more sources