ACA push enters new phase with clock ticking

Axios – Friday, November 17,2025
By Peter Sullivan

The battle over renewing Affordable Care Act tax credits is entering a new phase, with shifting alliances and a tight timetable complicating prospects for any bipartisan deal.

Why it matters: Without an extension by the end of the year, premiums will more than double on average for roughly 20 million Americans on the ACA marketplaces.

The impact of that increase will put more focus on health costs ahead of the midterms.

Driving the news: The focus of efforts to extend the subsidies is shifting from the bipartisan “gang” of senators who led talks to reopen the government to the Senate Finance Committee, which has scheduled a Wednesday hearing on health care costs.

Finance Chairman Mike Crapo (R-Idaho) is expected to play a leading role on the GOP side, along with health committee Chair Bill Cassidy (R-La.), a physician who’s also on Finance.

Finance Ranking Member Ron Wyden of Oregon is a key player on the Democratic side, along with Minority Leader Chuck Schumer.

A Schumer spokesperson said: “The bill Democrats bring to the floor will be a caucus product.”

The big picture: There is plenty of skepticism about a deal getting done in the remaining weeks of the session, since it would take 60 senators to overcome a filibuster.

If efforts to negotiate an extension go nowhere, Senate Republicans are likely to put forward an alternative plan that would be voted alongside Democrats’ bill.

Prospects are even dimmer in the House and in the White House, where President Trump has suggested sending subsidy money directly to consumers, in the form of a health savings account or flexible spending account.

Similar plans have been pushed by Cassidy and some other Senate Republicans, which would make it even harder to get a bipartisan agreement.

Between the lines: Democrats, whose starting position is a clean subsidy extension, believe they’re on strong political footing heading into an election year when rising costs will be Topic A.

But if the Democrats want a deal, they’ll have to agree to certain changes to the subsidies, which most Senate Republicans say are called for.

Those could include an income cap to prevent wealthier people from receiving the tax credits, as well as a requirement that recipients pay a minimum premium, which Republicans say will help fight fraud and free-riding.

Democratic Sen. Jeanne Shaheen (N.H.), lead sponsor of a bill that would extend the subsidies, has said she is open to those changes.

Yes, but: Probably a bigger obstacle is abortion, specifically new GOP-backed restrictions against taxpayer money going to ACA plans that cover abortion.

“We’re not doing something without the Hyde Amendment attached,” Sen. Katie Britt (R-Ala.) told reporters, referring to restriction on abortion funding.

Democrats say there is already a segregation of taxpayer funds built into the ACA, and that the GOP is using the fight to expand abortion restrictions.

Trump and many congressional Republicans have been stepping up their messaging against the ACA in general, with Trump calling the subsidies a “disaster” that benefits insurance companies.

What’s next: Some Senate Republicans say they are at least open to talking about a bipartisan fix.

Sen. Chuck Grassley (R-Iowa) said after a Monday meeting of Finance Committee Republicans that there is not “consensus” on what to do on health care, but he thinks a deal is possible in the next month.

Sen. Jim Justice (R-W.Va.) said he’ll “be open-minded,” adding, “Let’s see how all this plays out.”

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