Some Senate Republicans are expressing frustration that their caucus has not been able to unite behind a health care plan ahead of a vote next week on a Democratic proposal to extend health insurance premium subsidies that expire in January.
Republicans are worried about subsidies, and costs of health insurance more broadly, becoming a major issue in the 2026 midterms that — in the worst case — could cost them the Senate majority.
The GOP has no agreement on how to move forward on the issue, which could prompt a group of Republican senators to cross the aisle next week and vote for a Democratic bill to extend subsidies under the Affordable Care Act (ACA).
Republicans say they don’t have an alternative proposal to address rapidly rising insurance premiums for a vote next week, with some GOP senators frustrated by Democrats’ lack of a clear strategy to counter the bill.
“I don’t think we’ve united as a conference around a plan, so no, I’m not satisfied,” said Sen. Lisa Murkowski (R-Alaska). “I hope we have something that can actually get 60 [votes] for.”
Senate Health, Education, Labor and Pensions Committee Chairman Bill Cassidy (R-La.) and Senate Finance Committee Chairman Mike Crapo (R-Idaho) led a discussion Tuesday about concepts and proposals that could be part of the Senate GOP health care plan, but senators said it won’t be ready until next week.
Cassidy unveiled a proposal to leave the original ACA premium tax credits in place but convert funds for enhanced premium tax credits into contributions to health savings accounts that Americans can use to pay for out-of-pocket health care costs.
But Republican senators said they had not yet seen the text of Cassidy’s plan.
“There’s really no tough proposal,” said Sen. Ron Johnson (R-Wis.).
Sen. Thom Tillis (RN.C.) warned that failure to respond to rising health insurance premiums is going to be a political problem in next year’s midterm elections.
“There’s going to be a lot of sympathetic cases that Democrats are going to use in campaigns next year,” he told a reporter for HuffPost.
Sen. Josh Hawley (R-Mo.) has warned that nearly half a million constituents in his home state will be affected when enhanced subsidies expire.
“I think it’s going to be very painful for people who work a lot,” he said. “They’ll look and say, ‘What are you doing to help me afford health care and get my kids to the doctor?’
“We need to do something at a premium. This is a time of crisis, it’s time for leaders to lock themselves in a room and figure out what to do,” he added. “If they can’t figure out a plan, then maybe, well, you have to do some kind of short-term extension until we figure out a plan.”
A group of centrist Republican and Democratic negotiators worked over the Thanksgiving break to make progress toward a bipartisan deal, but they said it would not be ready in time for a vote next week. That is fueling pessimism about any deal this year.
“There are still a lot of talks going on, but I think it will be difficult to get anything until next week,” said Sen. G.N. Shaheen (DN.H.), who played a key role in the negotiations.
Shaheen, who has been in touch with House colleagues, said that even if the Senate passes the bill, it’s becoming clear that Speaker Mike Johnson (R-La.) will not bring it up for a vote.
“What I’m hearing is that Speaker Johnson is unlikely to take up any bills and it will have to be done by discharge petition,” she said.
Some want to block the speaker’s control of the House floor by collecting 218 votes on a discharge petition — a strategy that worked last month to force a vote on the Epstein Files Transparency Act — but that’s a long-shot option that could take weeks or possibly months.
Senate Republicans are divided on whether they should try to unite behind an alternative health care plan. Some Republican lawmakers worry that their own proposal will split their party and give Democrats a target to attack ahead of the 2026 midterms.
Sen. John Cornyn (R-Texas), who is up for re-election next year and faces a tough primary challenge, said Republicans could bring a resolution to the floor to highlight problems with the Affordable Care Act.
“I don’t see any way under the sun that we would support an expansion of the current broken system,” Cornyn told reporters Wednesday, predicting that no bill to extend the enhanced ACA subsidies would pass.
Asked if Republicans might not even offer an alternative plan, Cornyn said: “There are different ideas.”
“Republicans have always had trouble uniting around an alternative health care proposal,” he added. “There are some suggestions for targeting specific elements of the situation [law] Show your problem.”
That would allow GOP candidates in next year’s election to blame Obama-era legislation and enhanced insurance premium subsidies that former President Biden signed into law during the COVID-19 pandemic as the main drivers of rising health insurance premiums.
“If you think about what the government has done, everything they’ve done has made everything more expensive: cars, health care, housing,” said Sen. Rick Scott (R-Fla.).
Sen. John Howen (RN.D.) said he expects Senate Republicans to offer an alternative proposal next week to extend expiring premium subsidies to GOP colleagues to vote against the Democratic bill.
“They’ll probably keep their three-year extension” of the subsidies, he added, adding, “We’ll keep some, too. At that point you won’t pass one, and then we’ll go back to work.”
Hoven said Republicans will highlight their support for more federal funding of health savings accounts that U.S. consumers can use to reduce their out-of-pocket costs, as well as their support for reforming the federally managed health insurance marketplaces to require low-income Americans to pay something for their coverage.
“We understand that we want to get something in place quickly because of the impact of those premium increases,” he said.
Senate Democratic Leader Chuck Schumer (NY) has yet to reveal what Democrats will bring to the floor next week to help Americans cope with rising health insurance premiums, but Senate Democratic sources predict the bill will be a three-year extension of ACA subsidies to match House Democrats’ support.
Senate Majority Leader John Thune (R.D.) said Wednesday that how Republicans plan to respond to Democrats’ bill to extend subsidies will depend on how that proposal is framed.
Thune said there is broad Republican support for allowing self-employed individuals and small businesses to participate in “association coverage” and collectively negotiate better health insurance rates or buy into plans offered by Costco and Walmart across state lines.
“Buying across state lines, allowing people to join larger groups — to go from the individual market to the group market … that’s one way you can significantly address the issue of cost and affordability,” he said. “It will be a part of anything we do. Obviously some of that will take some time to implement.”
This story was updated at 6:26 p.m
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