Health package might move ahead without ACA deal

Axios – Wednesday, January 14, 2026
By Peter Sullivan

Congressional negotiators are working to revive the health care deal that was dropped from a government spending package in late 2024 — but the odds of resurrecting enhanced Obamacare subsidies as part of the effort appear dire.

Why it matters: Long-stalled bipartisan priorities that are in play include an overhaul of pharmacy benefit manager practices, as well as a measure that would place more controls on Medicare outpatient spending.

They’d likely be combined with a renewal of health programs due to expire Jan. 30, including certain Medicare telehealth flexibilities and funding for community health centers.

Driving the news: Leadership and health committees in both parties have quietly swapped offers on a package over the past week while attention was primarily focused on the fight over expired Affordable Care Act tax credits.

Democrats included a three-year extension of the ACA subsidies in their latest offer knowing that GOP leadership is likely to reject it, sources said.

That would still leave intact most of the health care deal that was destined to ride on a government funding package before it was scuttled at the last minute by Elon Musk and then President-elect Donald Trump.

What we’re hearing: Asked about the likelihood of a health package without the ACA subsidies, Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) pointed to the overwhelming 26-0 vote in his committee for the PBM overhaul in 2023.

“I’m not going to negotiate with myself but the reality is I think a 26-0 vote in the Senate … it’s like unheard of,” Wyden told Axios, adding he is “feeling upbeat” about getting the PBM bill over the finish line.

Senate Finance Chairman Mike Crapo (R-Idaho) also told Axios he is “feeling optimistic” about the PBM bill, saying there is “broad support here and at the White House.”

That measure includes provisions like “delinking” the price of a drug from PBM compensation in Medicare Part D.

The prospective package would also include a measure that would require off-campus hospital outpatient departments to have a unique identifier number.

It’s a cost-saving measure designed to prevent outpatient departments from billing payers at higher amounts associated with full-service hospitals.

But it would stop short of a full-scale, more sweeping change known as site-neutral payments that would more closely align Medicare payments to hospital outpatient departments with freestanding physician offices.

The intrigue: The outlook for renewing enhanced ACA subsidies, which help millions of Americans afford their premiums, is much bleaker.

While a separate bipartisan group of senators continues to meet in search of a compromise, a key negotiator, Sen. Bernie Moreno (R-Ohio), told reporters on Tuesday that a release of a proposal would be punted until after next week’s Senate recess.

Even if the group can release a proposal — which would include GOP-backed changes like eliminating $0 premium plans — there is deep skepticism in both parties that it can actually pass.

Many Republicans are opposed to any kind of ACA subsidy extension, saying it is wasteful spending that benefits insurance companies.

Top Democrats are pushing for a clean subsidy extension without GOP-backed changes and blasting Republicans for blocking it, in what could be a preview of midterm campaign messaging.

Between the lines: There still are significant divisions over whether to include new limits on the ACA funding going to plans that cover abortions.

The bipartisan group has discussed a potential compromise that would increase audits and levy penalties on insurance companies that don’t comply with existing rules requiring them to segregate taxpayer money from paying for abortions.

The idea immediately drew fire from the anti-abortion group Susan B. Anthony Pro-Life America, and many Senate Republicans think it does not go far enough.

The bottom line: There still could be an election-year health deal — just don’t expect it to address ACA subsidies.

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