As of Friday, December 12, 2025 Congress has failed to pass any solution to prevent premium increases set to take effect January 1, 2026. If you’ve been following our previous Policy Corner posts on the government shutdown and the status of enhanced ACA subsidies, you’ll know that the struggle surrounding how to address these expiring subsidies has been ongoing.
Senate Fails to Pass Dueling Healthcare Resolutions
The Senate voted on two competing bills on Thursday, December 11, 2025, and both failed to advance ahead of the December 31 deadline to address the premium increases.
Senate Democrats proposed a three-year extension of the enhanced premium tax credits (the subsidies that help lower your monthly insurance costs). The bill, which was introduced by Senate Minority Leader Chuck Schumer, received 51 votes in favor, short of the 60 needed to overcome the “filibuster threshold,” and 48 against. Four Republican senators—Susan Collins of Maine, Josh Hawley of Missouri, and Lisa Murkowski and Dan Sullivan of Alaska—joined all Democrats in support.
On the other side of the aisle, Senate Republicans offered an alternative that would have eliminated the enhanced tax credits and instead created health savings accounts (HSAs) for people who purchase bronze-level or catastrophic health plans on the ACA marketplaces. Individuals between 18 and 49 years old earning less than 700% of the federal poverty level would receive $1,000 in HSA funding, while those between the ages of 50 and 64 would receive $1,500. This proposal also received 51 votes in favor and 48 against. The bill was sponsored by Senators Bill Cassidy of Louisiana and Mike Crapo of Idaho.
Senate Minority Leader Chuck Schumer noted after the votes that the Democratic proposal had bipartisan support, while the Republican bill did not receive any Democratic votes. Senate Health Committee Chairman Bill Cassidy countered that Democrats needed to “stop playing politics” and work toward compromise.
What This Means for Your Premiums
Without action from Congress before the end of December, here’s what will happen on January 1st:
Premium increases will be steep. According to the nonpartisan health policy research organization KFF, premiums will roughly double on average for people enrolled in marketplace plans. The Urban Institute projects that people will pay approximately $1,000 more per year in premiums.
Everyone with marketplace coverage will be affected. This isn’t just impacting a small group—every person who purchases insurance through the ACA marketplaces will see their costs increase. For some, like Bartley Armitage who testified before the Senate Finance Committee in November, premiums could increase by as much as 500%. Mr. Armitage shared that his and his wife’s monthly premium would jump to over $2,000.
Older adults and those in rural areas will be hit hardest. At the recent Senate Finance Committee hearing, Jason Levitis, Senior Fellow in the Health Policy Division at the Urban Institute, noted that premium increases will be particularly severe for people ages 50-64, those living in rural communities, and self-employed individuals.
Millions will lose coverage entirely. The Congressional Budget Office estimates that nearly 4 million people will become uninsured over the next decade as a result of these premium increases. Many people simply won’t be able to afford coverage.
High utilizers of healthcare face the greatest risk. For patients managing chronic conditions who require regular infusion or injection therapies, losing insurance coverage or switching to a plan with higher out-of-pocket costs could be devastating. These aren’t optional treatments—they’re essential to managing serious health conditions. The increased financial burden could force difficult decisions about whether to continue necessary care.
Why No Deal?
Republicans and Democrats never engaged in meaningful negotiations on this issue, even after a small group of centrist Democrats made a deal with Republicans in November to end the 43-day government shutdown in exchange for a vote on the subsidies.
Republicans have criticized the Affordable Care Act since its passage in 2010, arguing that healthcare remains too expensive and that the enhanced subsidies mask deeper structural problems with the law. At the Senate Finance Committee hearing on November 19th, some Republican witnesses raised concerns about fraud in the subsidy system. Brian Blase, president of the Paragon Health Institute, claimed that 40% of enrollees in fully subsidized plans did not file a single health insurance claim, suggesting improper enrollment. However, according to analysis from KFF, experts note that it’s not unusual for people to have coverage and not use it in a given year, and that the data requires more context to understand enrollment patterns.
Republicans also argued that the enhanced subsidies primarily benefit insurance companies rather than patients. At the November hearing, witnesses advocating for Republican positions promoted alternatives like health savings accounts, association health plans, and short-term limited-duration insurance as ways to reduce costs and give patients more control.
Democrats maintained that extending the subsidies was the only practical solution that could be implemented in time to prevent January premium increases. At the same November hearing, Jason Levitis from the Urban Institute testified that building an entirely new system—like the HSA proposal—would require months to set up the technology infrastructure, testing, and deployment. By that time, the open enrollment period would be over, leaving millions without relief.
Democrats also rejected Republican proposals as inadequate. Senator Tina Smith of Minnesota pointed out during the hearing that HSA funds wouldn’t help people afford their coverage in the first place.
According to reporting from the Associated Press, negotiations broke down in part over Republican demands to add new restrictions on abortion coverage, language that Democrats described as a “red line” they wouldn’t cross. Senator Smith emphasized during the November hearing that current federal law already prohibits federal funds, including ACA tax credits, from being used to pay for abortion care, and questioned why additional restrictions were necessary.
What Happens Next
On December 12, House Republican leaders announced plans to vote on a newly unveiled health care package containing policies with broad Republican agreement. The Lower Health Care Premiums for All Act includes funding for cost sharing reductions, expansion of association health plans, CHOICE arrangements, and access to stop-loss insurance, as well as a pharmacy benefit manager transparency provision that would require PBMs to provide employers with detailed data on prescription drug spending, rebates, spread pricing, and formulary decisions. While the package excludes an extension of the expiring ACA subsidies, GOP leaders have said that they will allow an amendment vote on an extension.
Multiple competing proposals have been put forward in the House, including the Republican partisan package, Democrats’ proposed clean extension, and several bipartisan proposals offering shorter extensions with new income eligibility limits.
Time is running out, with only days left before lawmakers leave for their holiday break. The federal and state marketplaces have already built the technology infrastructure to restore the enhanced tax credits if Congress acts, as they’ve been preparing for this possibility for months.
How to Prepare
While we hope Congress will still act, it’s important to be prepared:
Review your coverage options. December 15 is the last day to enroll in or change plans for coverage to start January 1. Open enrollment officially ends on January 15, after this date, you have the option to enroll in or change plans only if you qualify for a Special Enrollment Period. Even with higher premiums, maintaining coverage is critical, especially if you have ongoing healthcare needs. Check out Healthcare.gov for more information.
Explore financial assistance. Review the Patient Assistance Programs noted on our website that may help with out-of-pocket costs related to infusion and injection therapies. See if your medication’s manufacturer offers a patient assistance program or copay assistance.
Talk to your healthcare provider. If you’re concerned about affording your treatments, have an honest conversation with your healthcare team about resources or alternative options.
Don’t go without coverage if possible. Healthcare costs without insurance can be catastrophic, especially for those managing chronic conditions.
Looking Ahead
We will continue monitoring developments in Congress and will provide updates as new information becomes available. This situation remains fluid, and there is still a possibility that Congress could act before January 1st. We encourage you to stay informed and prepared.
