WASHINGTON — The Republican-led House and Senate adjourned Thursday until the new year with no solution on expiring health care subsidies under the Affordable Care Act, meaning insurance premiums for about 22 million Americans will rise next month.
But despite opposition from House Speaker Mike Johnson, R-La., and Senate Majority Leader John Thune, R-S.D., some lawmakers in both parties hope there’s still a path to act in 2026.
And if that fails, Democrats say they’re determined to wield the issue to impose maximum political pain on Republicans in next year’s midterm elections.
“They are absolutely screwing over millions of people, including my constituents, which pisses me off,” said Rep. Pat Ryan, D-N.Y., who represents a competitive district in the Hudson Valley. “It’s just pathetic. The last time there was a major national Republican effort to repeal the ACA, we had an overwhelming wave where they got absolutely wiped out, and I think that’s likely what will happen here again.”
Before the House left town, four swing-district Republicans made a late scramble to revive the issue, successfully teaming up with Democrats on a “discharge petition” to force a vote on a three-year extension of Affordable Care Act funds. That vote is expected in the week of Jan. 5 when the House returns to session.
Republican Reps. Brian Fitzpatrick, Rob Bresnahan, Ryan Mackenzie, all of Pennsylvania, as well as Mike Lawler of New York, joined 214 Democratic signatories to end-run Johnson, who has called for letting the enhanced subsidies expire.
“I do believe if the bill comes to the floor, not only will it pass, but it’ll give the Senate the ability to come back with a bipartisan compromise and actually get something passed into law,” Lawler said Wednesday on NBC’s “Meet The Press Now.”
GOP leaders say they want to end the Covid-era funds, which were first passed by Democrats in 2021 on a party-line basis. Many Republicans want the money to elapse on schedule, but others say they're open to a temporary extension if paired with limitations or a phase-out.
House and Senate Republicans offered competing bills with a collection of conservative ideas in each chamber, neither of which would restore or replace the ACA funds. House Republicans passed their proposal on Wednesday, but it is unlikely to become law.
Rep. Madeleine Dean, D-Pa., said Republicans in swing districts are now realizing the political perils of inaction.
“I was literally in Mr. Bresnahan’s district on Saturday at a town hall attended by more than 200 people,” she said. “They all know that he went against them with the ‘big, beautiful bill’ vote on the Medicaid cuts. And so they got the message. They’re in trouble.”
Numerous Republican senators told NBC News that the House bill is dead on arrival across the Capitol — including some who favor an ACA funding extension at least on a short-term basis.
“There’s no way it’s going to sail through,” said retiring Sen. Thom Tillis, R-N.C., an early proponent of extending the funding who opposes doing so for a full three years absent reforms. “I would expect the vote count if it were just purely this wouldn’t be probably the same as it was last week.”
The Senate voted down the three-year ACA funding extension last Thursday on a vote of 51-48, with four Republicans joining Democrats — far short of the 60 votes needed to break a filibuster.
Even centrist Sen. Susan Collins, R-Maine, who has long broken with her party on the ACA, declined to endorse the House bill that’s headed to a vote, even if it were to pass the chamber.
“What we’re trying to do is to put together a bipartisan bill that would have reforms plus a two-year extension,” Collins told NBC News. “That is the best approach, in my opinion, and we’re making good progress.”
She said House passage of the bill would help “keep momentum going,” but added: “I think we need a bill that also has some reforms, such as an income cap, to just give you an example.”
Sen. Lisa Murkowski, R-Alaska, also said the House bill is unlikely to pass the Senate, but that it could be the vehicle for a deal between the two parties in the upper chamber.
“It’s too late to avoid the shock factor, but it’s not too late to do something about it,” Murkowski said. “And so I refuse to be in the camp that says, well, you just have to give it up then.”
Sen. Jim Justice, R-W.Va., said it’ll be “tough” for his constituents if the ACA funds expire with no off-ramp or replacement.
“We’ve got to give people an exit ramp. My proposal was: do 90% now, 60% in a year, 30% in the year, and then it wouldn’t be too easy, too difficult to step away from it,” Justice said.
He said his fellow Republicans need to appreciate the financial pain that Americans would feel if the money simply dries up.
“They better. Honest to God, they better,” he said. “If they don’t, they’re living in a cave.”
Sen. Mike Rounds, R-S.D., another proponent of some kind of ACA funding extension, said one major problem with a bipartisan deal is the dispute over “Hyde” language, referring to the law that prohibits federal funding for abortions. Republicans want to beef up abortion restrictions tied to the Obamacare money, which Democrats say is a nonstarter.
“There’s people working on it,” Rounds said, while adding that he’s not sure if they’ll find a way to resolve the issue.
Thune demurred on what the Senate would do if the House’s three-year funding bill passes.
“We’ll cross that bridge when we come to it,” he said.
Senate Minority Leader Chuck Schumer, D-N.Y., indicated it might already be too late, saying that after Jan. 1, when higher premiums kick in, it will be “very hard to put that toothpaste back in the tube.”
Meanwhile, Democrats are indicating that they won’t seek to tie ACA funding to the Jan. 30 deadline to fund the government. They used that tactic in the fall and it led to a record 43-day shutdown — while Republicans held firm in opposition to an extension of the money.
“I don’t see that,” said Sen. Jeanne Shaheen, D-N.H., one of the Democrats who relented and voted to reopen the government. “That’s just me.”
Sen. Josh Hawley, R-Mo., one of four GOP senators who voted to advance an ACA funding extension, said the original fight over the 2010 law predates him. He called on Republicans to get over their 15-year beef with Obamacare and help their constituents.
“People want us to do something to help them with the costs,” he said. “And I don’t think they really care about who voted for what 20 years ago. They care about their health care costs going up.”
