Overview
- The House voted 230-196 on Jan. 8 to extend enhanced Affordable Care Act tax credits for three years after 17 Republicans joined Democrats, but a clean renewal is unlikely to clear the Senate.
- A bipartisan Senate group is advancing a narrower two-year plan that would add income caps, minimum monthly premiums and enrollment guardrails, with legislative text reported to be nearing completion.
- President Donald Trump told reporters he might veto the House bill if it reached his desk, signaling potential White House resistance to a long-term extension.
- Hospitals and health systems report preparing for higher emergency department volumes, more uncompensated care and widening access gaps, particularly in rural and underserved areas.
- CMS data show 93% of 24.3 million marketplace enrollees relied on the enhanced subsidies in 2025, and independent estimates suggest up to about 4.8 million could drop coverage if no extension occurs.