Overview
- Enhanced Affordable Care Act premium tax credits are scheduled to lapse on December 31 after the shutdown deal omitted an extension, even as open enrollment continues.
- Senate Republicans agreed to hold a December vote, but the House path remains uncertain as the White House and GOP leaders discuss early-stage alternatives such as direct cash or health‑account deposits.
- President Donald Trump urged replacing subsidies with equal cash payments, while Sens. Bill Cassidy and Roger Marshall proposed routing extra aid into patient spending accounts rather than premium discounts.
- Independent analyses warn of sharp cost increases and coverage losses, with KFF estimating average out‑of‑pocket premiums rising about 75% and the CBO projecting 4.2 million more uninsured over the next decade if enhancements lapse.
- State markets, insurers and clinics report mounting strain and consumer sticker shock, with reports of large premium jumps in Texas and Ohio, warnings of unaffordable coverage for up to 1.4 million Floridians, and concerns over rising uncompensated care.