Congress remains divided over how to address the expiration of enhanced Affordable Care Act subsidies, the issue that closed down the government last fall. In the new year, congress remains divided over how to address the expiration of enhanced Affordable Care Act subsidies, leaving millions of Americans facing higher health insurance costs while lawmakers work for a solution.
Earlier this month, the U.S. House passed legislation extending the enhanced subsidies for three years. The bill cleared the chamber on a 230–196 vote, with every Democrat supporting the measure and 17 Republicans bucking their party leadership and joining Democrats to get the bill passed. None of the Republican members of Congress from Kansas or Missouri supported the bill.
The enhanced subsidies, first enacted during the COVID-19 pandemic, significantly reduced monthly premiums for people who purchase insurance through the Affordable Care Act marketplaces. They expired at the end of 2025 after Congress failed to reach an agreement during last fall’s government shutdown.
Supporters of the House bill argue that restoring the subsidies is essential to preventing sharp premium increases and a rise in the number of uninsured Americans. The Congressional Budget Office estimates the three-year extension would increase federal deficits by roughly $80.6 billion over a decade but would also result in millions more people maintaining health coverage over the next several years.
Senate Negotiations and the Search for a Compromise
Despite House passage, the Senate has not approved an extension. Instead, a bipartisan group of senators has been working behind the scenes to craft a narrower compromise that could attract enough Republican support to pass.
Reporting on the negotiations indicates several Republican priorities aimed at tightening eligibility and plan design are being proposed in the bill. Those proposals include income limits to better target who qualifies for assistance, requirements that enrollees pay at least a small monthly premium to eliminate zero-dollar plans, and expanded use of health savings accounts.
Abortion policy has emerged as the most significant obstacle in the Senate talks. Republicans want stronger assurances that enhanced subsidies cannot be used for insurance plans that include abortion coverage. Democrats counter that existing law already prohibits federal funding from paying for abortion services and argue that adding new restrictions could limit coverage options and disrupt current marketplace rules.
Congress was on King holiday the week of Jan., 19 and only returned back Jan. 26 to to resume negotiations.
Enrollment Drops as Costs Rise
The debate is unfolding as enrollment numbers show early signs of decline. The last day to enroll for 2026 health coverage was Jan. 15, and the subsidy lapse appears to be depressing sign-ups.
According to the Centers for Medicare & Medicaid Services, enrollment is down compared with this time last year, with many consumers seeing sharply higher monthly premiums.
One reason is price shock. The health policy nonprofit KFF estimates that without enhanced subsidies, premium payments for previously subsidized enrollees could increase on average by $1,016 per year (114%). For some families, monthly premiums have more than doubled, leading many to delay enrollment or drop coverage altogether.
The Senate group developing a compromise bill has said it is committed to reopening the 2026 enrollment period for a limited time after — or if — the bill passes, allowing people who delayed coverage to sign up later in the year. Until that happens, however, many Americans could remain uninsured or postpone needed medical care.
Trump Releases Health Care Framework
Adding another layer to the debate, President Donald Trump last week released a brief, two-page health care framework outlining his administration’s approach to lowering costs. One page serves as a cover, while the second lists broad policy priorities rather than detailed legislative proposals.
The framework does not include an extension of Affordable Care Act subsidies. Instead, it emphasizes sending federal health care assistance directly to individuals rather than insurers. No dollar amounts are specified, but the approach is closely aligned with health savings accounts, which are typically paired with high-deductible insurance plans.
Health savings accounts allow individuals to set aside money — often on a tax-advantaged basis — to pay for medical expenses such as doctor visits, prescriptions and hospital care. Funds can roll over from year to year and grow tax-free, but the plans usually require higher out-of-pocket spending before insurance coverage begins.
The proposal also references funding cost-sharing reductions, which are built-in discounts within certain marketplace plans that lower deductibles, copays and other out-of-pocket costs for lower-income enrollees. These reductions are separate from premium subsidies and are designed to make care more affordable when people actually use their insurance.
Additionally, the framework calls for new insurance transparency rules that would require insurers to present clearer, plain-language information to consumers. This would include showing how much insurers spend on medical care versus administrative costs, how often claims are denied, and greater visibility into provider pricing — measures supporters say would help consumers better compare plans.
Uncertainty Continues
For now, the House has acted, the Senate remains divided, and the enhanced subsidies remain expired. With premiums rising and enrollment declining, the outcome of the Senate negotiations will determine whether relief comes soon — or whether millions of Americans face a full year of higher health care costs and reduced access to coverage.