The narrow, rocky path to a deal on enhanced ACA subsidies

Modern Healthcare – Wednesday, January 7, 2026
By Michael McAuliff

The majority-Republican Congress is about to take another, and probably final, stab at restoring enhanced subsidies for health insurance exchange enrollees.

The House is expected to vote this week on legislation that would renew the enhanced subsidies, which expired Dec. 31, for three years, retroactive to Jan. 1. And while a coalition of Democrats and a handful of Republicans is likely to secure passage in the lower chamber, the legislation faces long odds in the Senate, where it would need 60 votes to prevent filibusters.

The Senate considered the same bill last month and it failed to meet that threshold despite attracting a majority that included several Republicans. A cadre of Senate Republicans continues to work on a compromise measure but has not coalesced around a plan nor gained public support from Democrats.

The subsidies bill is coming to the House floor despite opposition from Speaker Mike Johnson (R-La.) and steadfast antipathy among the GOP for the Affordable Care Act of 2010 and the enhanced subsidies originally enacted in 2021.

Four House Republicans joined with all House Democrats on an extraordinary procedural tool that enables them to circumvent GOP leaders, called a discharge petition. When the House GOP leaders declined to take up an extension last month, the discharge petition secured enough signatures to represent a majority.

If those four Republicans stay on board, the measure has enough support to pass, likely Thursday.

But prospects after that get difficult.

For starters, Senate Majority Leader John Thune (R-S.D.) is not subject to the House’s discharge petition and can opt not to present the bill to the upper chamber despite exhortations from Senate Minority Leader Chuck Schumer (D-N.Y.) and anxiety among some Republicans about skyrocketing exchange premiums.

Moreover, the vote last month demonstrated that too few Senate Republicans want to renew the enhanced subsidies: Four GOP senators backed the Democratic bill, but 13 would be needed to reach 60 votes.

The alternative would be another version of the legislation that could win over more Republicans without alienating Democrats. That’s a long shot, and would require further House action if it cleared the Senate.

Thune reiterated Tuesday that a “clean” restoration of the subsidies without modifications is a nonstarter. Those could include provisions such as a shorter extension, income caps, minimum monthly premiums and expanded health savings accounts.

Democrats may be willing to swallow policies like those. “If we got two years instead of three — two is better than zero,” Sen. Peter Welch (D-Vt.) said.

But Republicans also aim to ban abortion coverage in exchange plans, based on the Hyde Amendment that bars federal funds from financing abortion care. “You’ve got to deal with the Hyde issue,” Thune said.

Democrats simply won’t support that, Welch said. “Abortion has got to stay out of this. It’s got to be status quo. If this gets turned into an abortion debate, then we all lose,” he said.

President Donald Trump could possibly sway his party to come to some sort of agreement. Trump met with Johnson and other Republican leaders Tuesday and urged them to be a “little flexible” on abortion and to emphasize health savings accounts.

“You can own healthcare. Figure it out. Let the money go to the people,” Trump said. “No money for insurance companies.”

Trump has repeatedly vacillated on the subsidies, however, and has not put his weight behind any of the efforts on Capitol Hill. Absent the president’s backing, congressional Republican leaders and conservative lawmakers are not likely to embrace legislation to shore up “Obamacare.”

Democratic leaders have stood firm against anything less than a three-year extension, and have declared Republicans will pay the price at the polls this November, suggesting they intend to use the issue as an election-year cudgel.

Optimism among lawmakers who support some form of subsidy extension is in short supply.

“From all their actions, they’re totally partisan,” Schumer said. “None of them say extend the credits. Thune and Johnson are against extending them for a day.”

Sen. Josh Hawley (R-Mo.), who voted for the Democratic bill last month, said the moment has passed and the parties are entrenched. “That was my fear back in December, that if we didn’t act before we left, you’d have sort of rigor mortis set in,” he said.

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