With only days left on the congressional calendar, lawmakers are negotiating a bipartisan health care compromise designed to prevent sharp premium increases in 2026 while reshaping how some health care dollars reach patients.
The proposal, known as the Bipartisan Health Insurance Affordability Act, pairs a temporary extension of Affordable Care Act (ACA) subsidies with expanded access to Health Savings Accounts (HSAs) — a key Republican priority. Supporters say the bill reflects a middle-ground approach aimed at lowering both monthly premiums and high out-of-pocket costs.
Rep. Sharice Davids, the lone Democratic member of Congress from Kansas, has announced her support for the compromise, calling it a practical solution to protect families from immediate cost hikes while Congress continues debating longer-term reforms.
“This isn’t everything I’ve asked for, but it’s exactly how Congress is supposed to work — finding common ground and making life more affordable for families,” Davids said.
“This isn’t everything I’ve asked for, but it’s exactly how Congress is supposed to work — finding common ground and making life more affordable for families.
Congresswoman Sharice Davids
What the Compromise Does — in Plain Terms
At its core, the bipartisan proposal does two things:
First, it extends ACA premium subsidies through 2027.
This prevents automatic premium increases that would take effect January 1 if Congress fails to act.
Second, it expands Health Savings Accounts.
HSAs allow individuals and families to set aside tax-free money to pay for medical costs like deductibles, copays, prescriptions, and other out-of-pocket expenses. Under the compromise, more people using ACA plans — including those in lower-cost plans — would become eligible to use HSAs.
Republicans argue that HSAs give patients more direct control over their health care dollars, particularly as deductibles continue to rise. Sen. Bill Cassidy of Louisiana, a physician and lead negotiator, has framed the accounts as a way to put money “in the patient’s pocket,” not just toward insurance premiums.
Additional Changes Included in the Bill
Beyond subsidies and HSAs, the compromise bill also includes provisions aimed at oversight, cost transparency, and enrollment protections. The proposal would:
- Strengthen oversight of insurance agents and brokers to prevent fraudulent enrollments
- Require audits, enrollment verification, and penalties for false information
- Increase transparency in prescription drug pricing by requiring pharmacy benefit managers to pass rebates directly to plans and employers
- Allow families to prepay premiums for additional savings
- Extend the ACA open enrollment period and improve notification requirements
- Automatically remove deceased individuals from coverage rolls
- Direct federal agencies to monitor compliance and report on prescription drug pricing practices
Supporters say these provisions address concerns raised by both parties — fraud prevention for Republicans and consumer protections for Democrats.
Why This Matters Now
Congress has only a few legislative days remaining this year to act before the enhanced ACA subsidies expire. Without an extension, premiums could rise sharply in 2026, potentially forcing millions of Americans to drop coverage.
Davids’ office estimates that Kansans could see average premium increases of 77 % if the subsidies lapse, with ripple effects across the insurance market as healthier individuals leave coverage.
While Davids has pushed for a permanent subsidy extension, she supports the bipartisan bill as the best available option to prevent immediate harm.
Open enrollment is already underway, and while Congress can still act after enrollment begins, delays increase uncertainty for families trying to plan their health care for the coming year.
For now, the bipartisan proposal represents the clearest path forward — if Congress can reach agreement in time.
The Bipartisan Health Insurance Affordability Act was initially introduced in the U.S. House of Representatives by Rep. Brian Fitzpatrick (R-Pa.), who was joined by a bipartisan group of members including Reps. Jared Golden (D-Maine), Tom Suozzi (D-N.Y.), Don Bacon (R-Neb.), Rob Bresnahan (R-Pa.), Marie Gluesenkamp Perez (D-Wash.), Donald G. Davis (D-N.C.), and Nicole Malliotakis (R-N.Y.).