Trump May Decide Whether Senate Reaches a Deal to Lower 2026 Health Premiums

Senate Deal on 2026 Premiums Hinges on Trump’s Involvement

Senate Republicans say a bipartisan agreement to curb health insurance premiums for 2026 could be within reach — but only if President Donald Trump becomes actively involved in negotiations. Lawmakers are racing against a mid-December vote to revive enhanced Affordable Care Act (Obamacare) premium tax credits that are set to expire at year’s end.

Before that vote, senators from both parties and the White House must decide whether to pursue genuine cross-party talks over premium relief or instead stage a political vote to play out during next year’s midterms.

Where talks stand

Sen. Shelley Moore Capito (R-W.Va.) told Semafor she believes "there’s really some honest, sincere negotiations going on." She cautioned, however, that a straight extension of the tax credits "would get voted down" by many Republicans. "There could be a negotiated product," she added. "I think there’s a real possibility for that, especially if the president weighs in on this."

“There’s a huge division in the [Republican] Party. And they’re never going to get well on it because half of them want to get rid of the ACA altogether.” — person familiar with Senate Democratic dynamics

Trump has publicly said he is open to negotiating with Democrats, while also calling for dismantling parts of the Affordable Care Act and directing subsidies straight to consumers. His recent emphasis on affordability could make a deal attractive to his supporters, though the White House declined to comment for this report. On Tuesday morning, Trump posted that Congress should not "waste" its time on anything other than sending money directly to consumers.

Costs, options and obstacles

Extending the enhanced premium tax credits unchanged would cost roughly $35 billion a year, according to lawmakers. Many Republicans favor adding an income cap on who would receive the enhanced subsidies, but they acknowledge it’s likely too late to change eligibility for 2026 rates. That narrows the most plausible path to a straight, temporary extension for 2026 with policy changes phased in for 2027.

Some GOP senators strongly oppose increasing federal spending on the current program. Sen. Tim Sheehy (R-Mont.) told Semafor he is a "hard no" on proposals that would funnel "more taxpayer money into a failed health care system."

A one-year extension, however, risks repeating a short-term showdown just before the midterms. With Thanksgiving recess starting soon, several senators say the timetable is tight and doubt negotiators can finalize a complex bipartisan package in time.

"We’re not going to be able to pull together bipartisan legislation in time for a December vote," Sen. Steve Daines (R-Mont.) said, adding that the issue's complexity makes a quick deal unlikely.

What to watch next

• Whether President Trump agrees to a sit-down with Senate Democrats and Republicans.
• Whether negotiators pursue a straight extension for 2026 and delay eligibility changes to 2027.
• How the looming recess and mid-December vote deadline shape any final legislation.

The coming weeks will determine whether lawmakers craft a bipartisan compromise to lower premiums or leave the politically charged question for the 2024 campaign season.