Senate leaders scheduled rival votes after Majority Leader John Thune pledged to allow a vote if Democrats helped end a lengthy shutdown. Democrats want a three-year extension of the 8.5% premium cap; KFF says that if the cap lapses, about 22 million people could see premiums rise an average of 114% in January. Republicans are divided, offering HSA-centered alternatives such as the Cassidy-Crapo plan, but GOP proposals lack Democratic support and face uphill odds in both chambers.
Senate Vote Puts Spotlight On GOP Split Over ACA Subsidies As Millions Face Higher Premiums
The Senate GOP is out of practice caring about health care
Senate Majority Leader John Thune (R-S.D.) kept a promise to moderate Democrats by scheduling a Senate vote on competing measures to extend Affordable Care Act (ACA) marketplace subsidies — a move that highlights deep Republican divisions and leaves millions of Americans at risk of steep premium increases if protections lapse.
Background
In 2021, Congress capped premiums for an average plan sold on ACA marketplaces so that consumers would pay no more than 8.5% of their income for benchmark coverage. That provision, enacted as part of Covid relief, is scheduled to expire at year’s end. Nonpartisan health policy group KFF estimates that if the cap ends, roughly 22 million people could face an average premium increase of about 114% in January.
What Democrats Are Proposing
Senate Democrats introduced a straightforward bill to extend the 8.5% premium cap for three years. The proposal is designed as a quick, targeted fix to prevent the immediate spike in out-of-pocket insurance costs for millions of people who buy coverage on the ACA marketplaces.
Republican Alternatives And Internal Divisions
Recognizing that most Senate Republicans would not support a three-year extension, Thune planned a floor vote largely to honor his commitment. But concern about political fallout has prompted some GOP lawmakers to seek their own alternative. Multiple Republican options circulated this week, most centered on delivering funds through health savings accounts (HSAs) rather than continuing the current premium cap.
The Cassidy-Crapo Framework: Senators Bill Cassidy (R-La.) and Mike Crapo (R-Idaho) proposed pairing HSA payments with bronze and catastrophic ACA plans for 2026–27. Under the proposal, eligible adults aged 18–49 with incomes below 700% of the federal poverty level would receive $1,000; those 50–64 would receive $1,500. The plan would bar HSA funds from being used for abortions and gender-transition procedures and would require states to verify citizenship and immigration status before enrolling people in Medicaid.
Democrats have labeled the Cassidy-Crapo bill a nonstarter; it lacks the seven Democratic votes needed to reach 60 votes to overcome a filibuster even if all Republicans unified — which they have not. Thune himself could not guarantee unanimous GOP support for the measure.
House Scene And Political Pressure
In the House, Speaker Mike Johnson presented a list of potential policies but offered no clear, unified path. The list ranged from expanding HSAs to reforming pharmacy benefit managers and included vague items like "innovation." That lack of direction frustrated vulnerable House Republicans, and a bipartisan, one-year extension of the subsidies has already attracted 16 Republican co-sponsors, signaling appetite among moderates for a quick fix.
What Comes Next
Even if a Republican alternative passed the Senate, it would likely face steep hurdles in the House and in overcoming Democratic opposition in the Senate. Some Democrats who accepted Thune’s promise have drawn criticism for participating in a vote perceived as symbolic, but the maneuver did shift public attention to Republicans — exposing a party out of practice at drafting consensus health-care policy and wrestling with the political risk of letting subsidies expire.
Bottom line: With the premium cap set to expire, lawmakers face a fast-moving deadline. The debate underscores urgent questions about affordability, political accountability, and whether Congress can deliver a bipartisan, durable solution before the costs hit millions of Americans.
