GOP Scrambles to Draft Health‑Care Plan as ACA Subsidies Near Expiration

Republican lawmakers are rushing to produce a GOP health‑care alternative before next week, when Senate Democrats are set to secure a vote on expiring Affordable Care Act (ACA) tax credits. Closed‑door meetings in both the House and Senate produced a list of possible options, but leaders remain deeply divided about whether to extend the subsidies and what a Republican plan should actually include.

Why this matters

If the enhanced ACA tax credits lapse after Dec. 31, many Americans could face significantly higher insurance premiums. That prospect has intensified pressure on Republican leaders to present a viable alternative quickly — both to address constituent concerns and to avoid providing Democrats with a potent campaign issue ahead of the 2026 midterms.

Where Republicans stand

In separate closed meetings Tuesday, Senate Republicans heard proposals from Finance Chair Mike Crapo and HELP Committee Chair Bill Cassidy, who has championed expanding health savings accounts (HSAs) as one alternative to simply extending tax credits. Senators discussed ideas including allowing greater flexibility in HSA use, imposing income caps on ACA subsidies, and requiring enrollees to make minimum premium payments.

Senate Majority Leader John Thune has agreed to give Democrats a vote on the subsidy issue as part of a deal to reopen the government, but he faces competing pressures from members who want an extension and those who prefer the subsidies to expire. Thune did not commit to a timeline for bringing a Republican measure to the floor.

House divisions

Across the Capitol, Speaker Mike Johnson for the first time told House Republicans he would put forward a health‑care framework in the coming days. Still, House leaders are wrestling with internal disputes — many conservatives oppose any extension of ACA subsidies, while moderates warn that failing to act risks harming their reelection chances.

House Majority Leader Steve Scalise heard strong concerns from centrist members, who said “something needs to be done” on health care before year’s end. Leaders say the decision will be shaped by the "will of the conference," even though a majority of House Republicans currently oppose an extension of the subsidies.

Efforts at bipartisan compromise

Some lawmakers are pursuing bipartisan paths. Representative Brian Fitzpatrick (R‑Pa.), co‑chair of the Problem Solvers Caucus, is drafting a bill aligned with a previously leaked White House framework and says his measure avoids contentious provisions on abortion to improve its chances of attracting Democratic votes. Fitzpatrick argues his bill could reach the 218‑vote threshold in the House.

“Have you ever heard of a Rorschach test? Let’s smear it all over the wall,” said Sen. John Kennedy (R‑La.), reflecting the wide range of ideas floating in GOP discussions.

Next steps and political stakes

Senate Republicans expect continued discussion this week, and Cassidy plans to highlight HSA changes at a HELP Committee hearing. But with no consensus yet, lawmakers warned that failing to coalesce around a plan could leave Republicans vulnerable in the 2026 midterms if subsidies lapse and premiums rise.

Contributors: Benjamin Guggenheim and Mia McCarthy.