US senators were set to vote Thursday on dueling health care plans that are both expected to be rejected, with millions of Americans facing soaring premiums and the issue poised to be a major flashpoint in next year’s midterm elections.
President Donald Trump has remained largely disengaged from Capitol Hill negotiations, according to lawmakers in both parties, reluctant to spearhead a major health care push and declining to endorse any proposal to extend expiring subsidies.
Without action, insurance payments for more than 20 million low- and middle-income Americans are projected to more than double in January, raising the political stakes as Washington edges into a campaign season defined by cost-of-living pressures.
Neither the Democratic nor Republican proposal has much chance of advancing, however, leaving looming uncertainty over enhanced Affordable Care Act (ACA) subsidies that expire on December 31.
The vote on the Democratic plan — a three-year extension of the subsidies — was secured last month as part of the deal that ended a record 43-day government shutdown.
But while Republican Majority Leader John Thune agreed to hold the vote, he has not promised its success, and Republicans appear unified in opposition.
Under pressure from moderates and senators up for reelection, Thune agreed to bring forward a Republican alternative for a vote alongside the Democratic bill.
This plan would replace subsidies with contributions to Health Savings Accounts to help cover out-of-pocket expenses. But it too has little hope of reaching the 60-vote threshold, with only 53 Republicans making up the majority.
The average payment is expected to rise by roughly 114 percent — an extra $1,000–$1,500 in annual premiums for a typical family — according to health policy research group KFF.
– ‘Half-baked ideas’ –
Up to seven million ACA enrollees could lose their coverage altogether, statistical modeling indicates, and most are expected to become uninsured rather than switching to other plans.
Thune, however, signaled that Thursday’s defeats might open the way for talks in 2026.
“When we get through this exercise this week the question is, ‘Are there enough Democrats who want to fix the problem?'” he told reporters on Wednesday, adding that he believed there was “a path forward.”
“Obviously we don’t have a lot of time to do this, but I think there are ways in which you could, where there’s a will.”
Republicans say they are unwilling to back a clean extension but believe the broader issue of rising health costs can be addressed early next year, potentially as part of negotiations over government funding due to expire on January 30.
They are hoping to use special Senate procedures to circumvent the 60-vote rule and go it alone, arguing that Democrats have little incentive to compromise in an election year — a calculation the minority party denies.
In the House, the landscape is even more fractured. Multiple Republicans — including the leadership — unveiled a plethora of ideas aimed at lowering costs, though none includes extending ACA subsidies or looks to have sufficient backing.
With competing petitions, no unified House strategy, and little sign of leadership buy-in, the chances of a bipartisan compromise emerging before year’s end appear slim.
Senate Minority Leader Chuck Schumer called on Republicans to abandon their “hodgepodge of half-baked ideas” in a floor speech Wednesday and back the Democratic health care effort.
“What we need to do is prevent premiums from skyrocketing, and only our bill does that,” he said. “It’s the last train out of the station to avoid these sky-high premiums from going up and up and up.”
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