The U.S. Senate on December 11, 2025, failed to advance two partisan proposals aimed at addressing rising health insurance costs on the Affordable Care Act marketplaces before enhanced federal subsidies expire at year’s end. Democrats pushed a three-year extension of the subsidies, while Republicans backed redirecting federal assistance into health savings accounts, but neither bill secured the 60 votes needed to move forward, leaving millions of Americans facing steep premium increases without further congressional action.
On December 11, 2025, the Senate voted on two competing health care bills related to the Affordable Care Act (ACA), but both failed to clear the 60-vote threshold required to overcome a filibuster. The outcome had been widely expected after Democrats and Republicans opted to move forward with separate partisan proposals rather than a negotiated compromise, NPR reports.
The Democratic-backed plan — described in NPR coverage as a three-year extension of the enhanced ACA subsidies first introduced during the COVID-19 pandemic and set to expire at the end of 2025 — failed on a 51–48 vote. Four Republicans joined Democrats in supporting the measure, according to multiple outlets. The enhanced subsidies, created in 2021, have lowered premiums for marketplace plans for more than 20 million people, and analysts project that allowing them to lapse will lead to sharp premium increases beginning in 2026.
Estimates of the cost of a three-year extension vary. The Associated Press has reported a figure of about $83 billion over three years, while other analyses have suggested a somewhat lower range. Lawmakers and aides have cited different estimates depending on assumptions about enrollment and income eligibility, but there is broad agreement that a multi‑year extension would require tens of billions of dollars in new federal spending.
NPR reports that Democrats’ proposal focused on continuing the enhanced tax credits and maintaining support for outreach and enrollment assistance, such as funding for navigators who help consumers sign up for coverage. Some Democratic lawmakers also discussed administrative changes — such as easing automatic renewals and providing more time for people to enroll — though specific legislative language on extended open enrollment periods has not been uniformly detailed across public summaries.
The Republican-led proposal, authored by Senators Bill Cassidy of Louisiana and Mike Crapo of Idaho, would have allowed the enhanced subsidies to expire on schedule and instead offered new federal payments into health savings accounts. According to NPR, the plan would have provided up to $1,500 a year in HSA contributions for people earning up to 700% of the federal poverty level, tied to high-deductible health plans.
Under the GOP bill, those HSA funds could be used for out-of-pocket costs such as copays and certain medical expenses but not to pay monthly premiums, NPR and other outlets report. The bill also did not extend the ACA premium tax credits themselves. Senate Democrats criticized the proposal as doing little to address rising premiums and as shifting more financial risk onto patients.
The Cassidy–Crapo measure failed 51–48, short of the 60 votes needed to proceed, NPR reports. Most Republicans backed the bill, while Democrats were unified in opposition. The measure included provisions related to abortion coverage and gender-affirming care: NPR notes that Democrats objected to restrictions that would limit abortion coverage in ACA plans and curb access to gender-affirming care, arguing that those provisions went beyond the scope of premium relief.
The stakes are high for tens of millions of Americans who buy insurance on the ACA marketplaces. The Associated Press has reported that more than 24 million people are currently enrolled in marketplace plans benefiting from the enhanced subsidies. Without an extension, average premiums for subsidized enrollees are projected to more than double in 2026, with some older adults and middle‑income consumers seeing far steeper increases, according to estimates cited by AP and NPR that draw on modeling by the health policy organization KFF.
Democrats, including Senator Jeanne Shaheen of New Hampshire, have warned that the lapse of enhanced subsidies could make coverage unaffordable for many older and lower‑income consumers who do not qualify for Medicaid. In a separate NPR interview, Shaheen argued that premiums are poised to "skyrocket" without congressional action and that "millions" could lose coverage or be forced to downgrade their plans. Individual stories highlighted in NPR’s reporting describe substantial projected premium hikes for older enrollees, particularly those just below Medicare age.
Republicans have countered that Democrats are overstating the impact. GOP lawmakers argue that the original ACA subsidies — in place before the pandemic-era enhancements — would remain for many enrollees and that extending the temporary increase in benefits would entrench what they characterize as an expensive and distortionary subsidy system. Republican leaders have also repeatedly cited concerns about "waste, fraud and abuse" in ACA-related spending, pointing to government watchdog reports that have flagged vulnerabilities in how subsidies and related payments are administered.
Specific numerical claims about the exact number of people who would lose all enhanced credits, the share of premiums covered on average, or dollar amounts allegedly paid out fraudulently vary by source and are not consistently detailed across major news outlets. For example, one conservative outlet has highlighted allegations that tens of millions of dollars were improperly paid on behalf of deceased individuals and that a large majority of test applications with false information were initially approved. Independent verification of precise figures, such as 23 of 24 fraudulent applications being accepted or $94 million in payments to the deceased, is not available in the NPR and AP coverage reviewed, and those numbers appear to derive from select interpretations of inspector general or oversight reports rather than from the bipartisan congressional analyses cited in mainstream reporting.
Despite deep partisan disagreement over how to structure aid, polling and anecdotal reporting from NPR and other outlets indicate that the enhanced subsidies themselves remain broadly popular with enrollees across party lines. Marketplace consumers interviewed by NPR and other news organizations have described facing projected premium increases ranging from several hundred dollars to well over $1,000 per month in 2026 if the enhanced credits expire, particularly among older adults not yet eligible for Medicare and lower‑income individuals who earn too much to qualify for Medicaid but rely on the exchanges for coverage.
The defeats of both Senate bills leave the future of the enhanced subsidies uncertain. House Republican leaders have signaled that they plan to bring forward their own health care affordability proposals in the coming days, NPR reports, though the conference has not yet coalesced around a single plan. Separately, some centrist House members from both parties are backing discharge petitions to force votes on more targeted extensions of the credits through 2026 or 2027, but it remains unclear whether those efforts will gather sufficient support.
Economists and health policy experts interviewed by NPR, AP and KFF say the sharpest impacts of subsidy expiration would likely fall on lower‑income people in states that have not expanded Medicaid and on older adults in their 50s and early 60s, for whom premiums are highest. While some estimates suggest per‑person annual premium increases in the hundreds of dollars, others project much larger spikes in certain markets, potentially exceeding $1,500 more per year for some enrollees. The precise impact will depend on final 2026 rate filings, household income, age and geography.
For now, with open enrollment for 2026 coverage already under way and the calendar year ending soon, millions of ACA customers and insurers are operating under the assumption that the enhanced subsidies will lapse on January 1 unless Congress can broker a late compromise.
