WASHINGTON — Congress has less than a month before health insurance premiums are set to spike for millions of Americans. And hopes of a deal to mitigate the pain are fizzling among lawmakers in both parties.
“I’m not hopeful that that’s going to happen,” Sen. Gary Peters, D-Mich., said. “We’ll keep trying to work at it, but I’m not feeling good about it right now. … Things are not coming together like I would’ve hoped that they would.”
Peters was among a group of senators seeking a health care deal when eight Democrats voted with Republicans to reopen the government last month, ending the record-long shutdown that Democrats had forced to try to extend Affordable Care Act money.
The group of eight agreed to end the shutdown after Senate Majority Leader John Thune, R-S.D., promised Democrats a vote on a health care bill of their choosing next week, a promise he reiterated Tuesday. But that would require 60 votes, and as Republicans struggle to coalesce around a proposal of their own, Thune said the two sides still aren’t close to an agreement.
“I haven’t seen yet what the Dems are proposing. I don’t think we’re close to a 60-vote threshold yet,” Thune told NBC News on Tuesday.
At issue are about $35 billion in subsidies under the Affordable Care Act that were passed in 2021, during the Covid pandemic, to lower premiums by capping them for “benchmark” plans at 8.5% of an enrollee’s income.
Inside a closed-door lunch Tuesday, Republicans received a “good presentation” on health care from Senate Finance Committee Chair Mike Crapo, R-Idaho, and Senate HELP Committee Chair Bill Cassidy, R-La., according to Thune.
“Conversations continue,” the majority leader told reporters afterward. “I don’t think, at this point, we have a clear path forward. I don’t think Democrats have a clear path forward.”
Democrats prefer a straightforward extension of the expiring ACA funds. Republicans, who control both the House and Senate, have ruled out a clean extension. But GOP leaders haven’t proposed an alternative plan to begin negotiations, as many rank-and-file Republican lawmakers want the ACA funds to end entirely.
The evening before the meeting, Cassidy declined to offer a timeline for when he might release his health care plan, saying that “it’s not entirely dependent upon me.” He said there “absolutely are some Democrats who are interested in hearing more” about his idea, without naming any.
Senate Minority Leader Chuck Schumer, D-N.Y., tore into the GOP as “enveloped in a five-alarm dumpster fire” on health care with no plan. He held his cards close to the vest when asked what bill Democrats will put to a vote next week.
“Stay tuned,” Schumer said after a lunch meeting with his conference. “We had a great discussion, and I will tell you this: We will be focused like a laser on lowering people’s costs.”
Without a solution that can become law, the vote is likely to become a political weapon for Democrats to use against the GOP in the upcoming 2026 midterm elections. And 2 1/2 weeks before the scheduled holiday recess, lawmakers see the writing on the wall.
“I think 60 [votes] is going to be a pretty tall order,” Sen. Steve Daines, R-Mont., said. “As you know, getting to 60 on anything in this town is not easy, and especially in a short time frame, on a complicated issue like health care.”
He posited that the next option for action on health care is likely January, when Congress will again have to fund the government or face a shutdown.
“I think Jan. 30 becomes an important date,” Daines said.
By that point, higher insurance costs will have taken effect. Many will see their premiums double or even triple beginning Jan. 1.
“I think it’s going to be hard” to avert the cliff, said Sen. John Cornyn, R-Texas, noting that President Donald Trump has called for taking the ACA funds and sending them to consumers. “But trying to get 60 votes for that by the end of the year is going to be really hard.”
“I’m focused on the Senate, but the House, I think, is even a harder nut to crack,” he added. “And so I think the president’s going to have to get personally involved.”
Thune added that a dispute over abortion limitations surrounding the health care funds is a major sticking point, with Republicans demanding additional restrictions and Democrats dismissing that idea as a nonstarter.
“There are conversations that continue. But as you know, the Hyde issue is a difficult, challenging one on both sides,” he said, referring to the Hyde amendment, which prohibits federal funding for abortions.
Even if the Senate managed to pass a health care bill, the prospects appear slimmer in the House.
“We’re having listening sessions with members of our conference,” Rep. Brett Guthrie, R-Ky., the chair of the Energy & Commerce Committee that oversees health care, told NBC News.
“We need to make health insurance more affordable. We all agree to that,” he said. “I’m not sure what the actual process is going to be to get there, but we’re going to work to get there.”
Guthrie said it remains to be seen “where the consensus” will fall within the House GOP on the expiring ACA funds. At minimum, he said he wants to end no-premium plans, requiring every enrollee to pay at least something and eliminate automatic renewal of insurance policies from one year to the next.
Democrats say they’re willing to negotiate on the structure of funds, including by imposing stricter income limits on eligibility and requiring a minimum premium payment. But they say there are already sufficient abortion restrictions on the money, which Guthrie — like GOP senators — said he wants to toughen up.
“Hyde language is very important to me,” Guthrie said. “Very important.”
Existing law bars federal funds from being used for abortion care under the ACA plans. But states have the option to create alternate revenue streams to cover abortion, like imposing a surcharge or providing the funding locally, which some do.
Republicans say they want to choke off those side-door options for supplemental abortion coverage. Pressuring lawmakers to hold firm is SBA Pro-Life America, an influential advocacy group fighting to ban abortion nationwide, which argued in a memo last week, “When abortion is included in subsidized plans, the American taxpayer is subsidizing all coverage of the plan.”
Meanwhile, House Speaker Mike Johnson, R-La., said he doesn’t know “what the consensus is” among Republican lawmakers who are working on health care. But he promised a GOP plan.
“I told everybody, we are going to respond. We understand the need of bringing down health care costs and at the same time raising access to care and quality of care,” Johnson said. “We’ll be pulling it together.”
Rep. Richard Neal, D-Mass., the top Democrat on the Ways & Means Committee which has jurisdiction over the ACA tax credits, said the time for the GOP to act is now. Once the premiums go up, he said, “the damage is done — then you can’t walk that back.”
If so, he vowed that Republicans would pay a political price.
“If they’re contemplating anything, it has to be preemptive,” he said. “You get that bill, you remember it.”
Rep. Don Bacon, R-Neb., who represents a swing district and is retiring, said it would be “political malpractice” for the GOP to allow the ACA funds to expire without an alternative.
“I do think there’s challenges in a midterm year with our party in power. It’s always hard. And then, the president’s poll numbers today were 36% in Gallup, and I don’t think our side should ignore that,” he said, referring to a poll where Trump’s approval rating with Republicans slipped into the 60s on handling of health care and Ukraine. “So I think there’s red flags, and our party should take that threat serious.”
“I take hope that the president initially said he was willing to compromise in this area. And then he got push back,” Bacon told reporters. “He said it, and the speaker called him back, said there’s not enough support.”