Overview
- Senate leaders promised Democrats a mid-December vote on the expiring enhanced premium tax credits, but senators in both parties say a bipartisan bill is unlikely on the tight timeline and would require 60 votes.
- President Trump is pressing to send subsidy dollars directly to individuals rather than insurers, signaling he will not support a straight extension of the current ACA structure.
- Republican senators Bill Cassidy and Rick Scott are developing proposals to route funds through health savings or flexible spending accounts or direct payments, an approach experts warn could pull healthier people out of ACA plans and push premiums higher.
- Democrats and several GOP moderates favor short-term extensions, including one- or two-year options with potential income caps, and House Democrats have filed a discharge petition to force a vote.
- If the enhanced credits lapse on Dec. 31, analyses from KFF and the CBO project average premiums could more than double and millions could lose coverage, with insurers’ 2026 rate-setting limiting rapid administrative fixes.