Senate rejects both ACA subsidy bills; extension unresolved ahead of Jan. 1
The Senate rejected both the GOP Cassidy–Crapo HSA alternative and Democrats’ clean three‑year extension of enhanced ACA premium tax credits after cloture votes failed to reach the 60‑vote threshold. With the enhanced subsidies set to expire Jan. 1 — putting roughly 24 million enrollees at risk of sharply higher premiums per KFF and other estimates — lawmakers said they would pivot to bipartisan negotiations, though the window to act is tightly compressed.
📌 Key Facts
- The Senate held dueling votes on rival health proposals — the GOP Cassidy–Crapo HSA plan (branded the 'Health Care Freedom for Patients Act') and Democrats’ clean three‑year extension of enhanced ACA premium tax credits (the 'Lower Health Care Costs Act') — and both measures failed in the Senate.
- The GOP Cassidy–Crapo HSA proposal, which Senate Republicans coalesced around after closed‑door meetings, would seed HSAs with roughly $1,000–$1,500 per year for exchange enrollees up to 700% of the federal poverty level, tie the payments to purchase of bronze/catastrophic plans, bar using the funds to pay premiums, and exclude abortion and gender‑transition services; it also contains provisions to cut or condition Medicaid funding for states covering undocumented immigrants and to require citizenship/eligibility verification for Medicaid.
- Republicans (including Sen. John Thune and bill sponsors) argued the HSA plan would lower premiums, deliver benefits directly to patients and save taxpayer money, while Democrats (including Sen. Chuck Schumer) called the plan 'junk,' 'phony' or a 'fig leaf' and said it would not extend ACA tax credits or could not be implemented quickly.
- The enhanced ACA premium tax credits that applied in 2025 are set to expire on Jan. 1, 2026 without congressional action; roughly 22–24 million people rely on the credits and KFF estimates average annual premiums for subsidized enrollees would rise about 114% (from $888 in 2025 to $1,904 in 2026), with typical marketplace deductibles near $7,000 and about one‑in‑four enrollees saying they might drop coverage if premiums doubled.
- Procedural votes began with the GOP bill up first; Senate Democrats, joined by Sen. Rand Paul, voted down the Cassidy–Crapo HSA alternative, and a subsequent cloture vote on the Democrats’ three‑year extension also failed to reach the 60‑vote threshold.
- Senators from both parties said they expect the partisan measures to fail and signaled immediate pursuit of bipartisan talks; Republicans cited a recent GAO sting and broader fraud concerns as part of their rationale for opposing a clean extension, while Democrats said the GOP plan lacked sufficient fraud controls and protections for higher‑income recipients.
- With Congress set to leave Washington until the New Year and time compressed, some Republicans warned a final resolution could slip into January after the subsidies lapse, shifting next steps to bipartisan negotiations and possible actions in the House.
📊 Relevant Data
In 2023, the uninsured rate for Hispanic people ages 0 to 64 was 17.9%, more than two and a half times the rate for White people at 6.7%.
Latinos are overrepresented in the uninsured population due to factors including employment in low-wage jobs without offer of coverage, immigration status restrictions, language barriers, and lower rates of employer-sponsored coverage.
Health Insurance Coverage and Access to Care Among Latino Americans: Recent Trends and Key Challenges — National Center for Biotechnology Information (NCBI)
California is estimated to spend more than $8.4 billion on taxpayer-funded Medicaid health benefits for illegal aliens in fiscal year 2025.
California to Spend $8.4 Billion This Year on Health Care for Illegal Aliens — House Budget Committee
In 2022, emergency Medicaid for undocumented immigrants accounted for only 0.4% of total Medicaid spending.
Emergency Medicaid for undocumented immigrants accounts for only 0.4% of state spending, study finds — ABC News
21% of transgender adults had insurance through Medicaid according to a 2023 survey.
Among consumers who attested to a race or ethnicity in the 2024 open enrollment period for health insurance marketplaces, 22% identified as Hispanic/Latino, compared to their overall U.S. population share of approximately 19%.
Health Insurance Marketplaces 2024 Open Enrollment Report — Centers for Medicare & Medicaid Services (CMS)
📊 Analysis & Commentary (1)
The Democratic base isn’t in the mood to compromise
"An opinion piece arguing that Democratic grassroots anger and preferences make rank‑and‑file Democrats reluctant to accept GOP compromise plans—such as converting ACA subsidies to HSAs or accepting caps and riders—thereby constraining leaders and shaping the upcoming Senate votes over extending enhanced ACA premium tax credits."
📰 Sources (10)
Senate rejects rival Obamacare bills. Here's what that means for ACA subsidies
New information:
- The Senate rejected the Democratic three‑year extension of enhanced ACA premium tax credits in a cloture vote that failed to reach 60 votes.
- With the earlier defeat of the GOP alternative, both rival Obamacare bills failed in the Senate.
- Without congressional action, the enhanced ACA subsidies remain set to expire on January 1, increasing costs for marketplace enrollees; next steps shift to potential bipartisan talks and House maneuvers.
Senate Dems block Republicans' HSA plan as Obamacare deadline nears
New information:
- Senate Democrats, joined by Sen. Rand Paul (R‑Ky.), voted down the Cassidy–Crapo HSA alternative.
- Details reiterated on the GOP plan’s structure: $1,000/$1,500 HSA seed funds up to 700% FPL, tied to purchase of bronze/catastrophic plans, with Hyde enforcement and exclusions for gender‑transition services.
- A vote on Democrats’ three‑year ACA subsidy extension is up next and is expected to fail, pushing toward bipartisan talks.
- Quote from Sen. Chuck Schumer criticizing the GOP proposal as a "fig leaf."
- Senate Majority Leader John Thune is prepared to hold a vote on another proposal next week.
WATCH LIVE: Senate expected to vote on ACA subsidies with premiums set to rise in 2026
New information:
- KFF estimates the average subsidized ACA enrollee’s annual premium payments would rise 114% if enhanced credits expire (from $888 in 2025 to $1,904 in 2026).
- KFF poll: about 1 in 4 ACA enrollees say they would be very likely to go without insurance if premiums doubled next year.
- Open enrollment timing detail: for Jan. 1 coverage, most states’ ACA sign-up window ends Dec. 15.
- Context: roughly 24 million people currently have ACA coverage; enhanced credits are set to expire Jan. 1.
Senate to vote on dueling health care bills with price hikes on the horizon
New information:
- Procedural votes set to begin at 11:30 a.m. ET Thursday, with the GOP bill up first.
- Democrats’ bill is identified as the Lower Health Care Costs Act (a clean three‑year extension).
- KFF estimate cited: annual premiums for ACA exchange enrollees would more than double without an extension.
- CBS pegs about 22 million low- and middle‑income Americans aided by the 2025 enhanced credits.
- Schumer labels the vote a 'moment of truth' for Republicans and ties the vote promise to the shutdown deal.
- Republicans cite a recent GAO sting finding fictitious applications were approved as part of their fraud concerns.
Dueling Obamacare plans set to fail as deadline nears, pushing Senate toward bipartisan talks
New information:
- Multiple senators (Thune, Cornyn, Rounds, King) say both partisan plans are expected to fail and express intent to pursue bipartisan talks immediately afterward.
- Sen. John Cornyn says a final resolution is likely to slip to January, after the enhanced subsidies expire.
- Article notes bipartisan discussions have already been occurring in the background, but both parties opted to stage partisan votes first.
- Sen. Angus King says strict Hyde Amendment enforcement sought by Republicans is 'not going to happen' with Democrats, highlighting a core negotiating hurdle.
- Timeline context: Congress leaves Washington next week until the New Year, compressing the window to act.
Senate to vote on dueling health care proposals as ACA premium hikes loom
New information:
- GOP Cassidy–Crapo plan would provide up to $1,500 per year to Health Savings Accounts for those under 700% of the federal poverty level.
- Funds in the GOP plan cannot be used to pay premiums and exclude abortion and gender‑reassignment services.
- Democrats say both votes are expected to fail, while Republicans lack certainty all GOP senators will back the Cassidy–Crapo measure (per Thune).
- Democrats argue time is too short to implement the GOP plan this year and push a clean three‑year ACA tax‑credit extension.
- KFF data cited: average deductibles around $7,000 for marketplace plans, underscoring affordability concerns.
- Quotes: Cassidy warns of 'fraudulent spending'; Schumer says GOP plan 'would not extend the ACA tax credits for a single day'; Reed says 24 million face losing subsidies at year’s end.
WATCH LIVE: Senate meets ahead of dueling health care proposal votes
New information:
- Republican senators publicly coalesced around the Cassidy–Crapo plan after a Tuesday lunch, despite prior internal differences.
- Sen. Bernie Moreno, who recently floated a two‑year extension with income caps, says he is now "hyper‑focused" on the Cassidy–Crapo bill.
- Sen. Josh Hawley said the consensus bill "isn’t perfect, but I’m willing to give it a go," adding Republicans "can’t do nothing."
- Majority Leader John Thune said Democrats’ three‑year extension "will fail" for lacking sufficient fraud controls/limits on high‑income recipients; Schumer called the GOP plan "phony" and "dead on arrival."
- Article reiterates that both bills lack the votes needed and that millions could face higher premiums when credits expire in January.
Thune says Senate GOP will bring up alternative health care bill for a vote
New information:
- Majority Leader John Thune publicly commits that Republicans will put their alternative health bill up for a vote alongside Democrats’ ACA subsidy extension.
- Names the GOP proposal as the 'Health Care Freedom for Patients Act' by Sens. Bill Cassidy and Mike Crapo.
- Policy detail: redirects funds to health savings accounts for bronze‑plan enrollees on the exchanges rather than extending enhanced tax credits.
- Thune’s framing/claim: the GOP bill lowers premiums, delivers benefits directly to patients, and saves taxpayer money.
- Sen. Chuck Schumer labels the Cassidy–Crapo plan 'junk insurance.'
- Context note: Democrats can bring their three‑year extension as part of the shutdown‑ending agreement; both measures are unlikely to reach 60 votes.
Senate Republicans land on Obamacare fix, tee up dueling vote with Dems
New information:
- Senate Majority Leader John Thune said Republicans coalesced around the Cassidy–Crapo HSA plan after a closed-door conference meeting.
- The Senate will hold dueling votes on Thursday on Democrats’ three-year subsidy extension and the GOP HSA alternative.
- The GOP bill includes additional provisions: reducing federal Medicaid funding to states that cover illegal immigrants; requiring states to verify citizenship/eligible status for Medicaid; banning federal Medicaid funding for gender transition services and removing those services from ACA essential health benefits; and applying Hyde-style abortion funding restrictions to the new HSAs.
- Direct quotes from Thune arguing Democrats’ plan benefits insurers and affluent Americans and that the GOP plan shifts benefits to patients.