Congress Scrambles to Prevent Spike in Health Costs as ACA Subsidies Near Expiration

Lawmakers are racing against the clock as enhanced Affordable Care Act (ACA) tax credits that have helped lower premiums for millions are set to expire at the end of the month. With Congress preparing to adjourn for the holidays, negotiators in both parties are scrambling to find a short-term fix that could shield Americans from a sharp rise in health-care costs.

What’s At Stake

The lapse of enhanced ACA subsidies would likely push premiums higher for many Marketplace enrollees and could leave hundreds of thousands without affordable coverage. Sen. Jon Ossoff warned that roughly 500,000 people in Georgia alone could lose access to insurance if the credits expire, and leaders on both sides say the consequences could be far-reaching.

Legislative Developments

Last week the Senate failed to advance competing health proposals supported by both parties, leaving the House to act — though prospects for a short-term extension before lawmakers depart appear slim. Speaker Mike Johnson has pledged a vote on a Republican bill that would restore a cost-sharing reduction program to lower premiums for some ACA enrollees, but that legislation would not extend the Covid-era enhanced subsidies set to lapse.

GOP leaders have indicated they may allow an amendment to extend the tax credits to reach the House floor after pressure from swing-state Republicans such as Rep. Brian Fitzpatrick (R-PA). Still, the compressed timeline — with Congress slated to leave for the holiday recess and not return until early January — makes a timely resolution difficult.

Speaker of the House Mike Johnson at the US Capitol, in Washington, DC, on Friday, December 12, 2025. - Graeme Sloan/Sipa USA/AP

Partisan Positions And Possible Compromise

House Minority Leader Hakeem Jeffries criticized the narrow Republican approach and has not signaled whether more Democrats would support procedural efforts to force votes on bipartisan extensions. The White House has expressed a preference for directing federal aid into patients’ pockets through health savings accounts (HSAs), complicating negotiations.

Sen. Bill Cassidy (R-LA), chair of a key health committee, expressed cautious optimism that a bipartisan deal could both provide direct payments to patients and briefly extend enhanced ACA credits for those most in need. Cassidy said, "Republicans have pushed that we would put money in the patients' pocket so that she has something to pay the out-of-pocket. Democrats are saying let's do something about premiums. I think... there is a deal that could be made. Why don't we do both?"

Sen. Jon Ossoff: "The vote that members cast, whether to extend these tax credits means people will live or people will die."

Outlook

Even if the House passes legislation, the Senate must still clear procedural hurdles — including reaching 60 votes to advance many proposals — and the White House's priorities differ from some congressional plans. If lawmakers fail to act before adjournment, Congress may be forced to revisit the issue in January or attach an extension to year-end spending legislation. In the meantime, patients, insurers and providers face mounting uncertainty.

What To Watch: Whether the House allows an amendment to extend ACA credits, whether negotiators can reach a bipartisan agreement that pairs direct payments with premium relief, and whether leadership in either chamber will change course to avert a coverage cliff.