Some Senate Republicans are growing increasingly frustrated that their party still hasn’t agreed on a health care strategy ahead of a key vote next week on a Democratic bill to extend health insurance premium subsidies set to expire in January.
Many in the GOP worry that the future of those subsidies — and rising health insurance costs in general — could become a major flashpoint in the 2026 midterm elections and, in a worst-case scenario for them, threaten their chances of winning or keeping a Senate majority.
Right now, Republicans have no unified approach. That’s raising the possibility that a group of GOP senators may cross party lines next week and back the Democratic proposal to extend the Affordable Care Act (ACA) subsidies.
Republican senators say they won’t have their own alternative ready in time to respond directly to that vote, leaving some of them uneasy about heading into a showdown with no clear counteroffer.
“I don’t think that we have coalesced as a conference around a plan, so no, I’m not satisfied,” Sen. Lisa Murkowski (R-Alaska) said. “I’m hoping that we actually have something we can get 60 [votes] for.”
On Tuesday, Senate Health, Education, Labor and Pensions Committee Chair Bill Cassidy (R-La.) and Senate Finance Committee Chair Mike Crapo (R-Idaho) led a discussion on ideas that could form the backbone of a Republican health care package. But senators say that whatever emerges from those talks won’t be ready by next week.
Cassidy has floated a proposal that would keep the original ACA premium tax credits in place but shift funding for the enhanced credits into contributions to health savings accounts, which Americans could then use to pay out-of-pocket medical costs.
So far, though, most GOP senators haven’t seen actual legislative text spelling out the details.
“There’s really not a hard proposal,” Sen. Ron Johnson (R-Wis.) said.
Sen. Thom Tillis (R-N.C.) warned that doing nothing to ease skyrocketing health insurance premiums would be a serious political liability in next year’s races.
“There are going to be a number of sympathetic cases that the Democrats are going to use in campaigns next year,” he told a reporter for HuffPost.
Sen. Josh Hawley (R-Mo.) has also raised alarms, noting that nearly half a million people in his state could be affected if the enhanced subsidies lapse.
“I think it will be very painful for a lot of working people,” he said. “They’re going to look and say, ‘What are you guys doing to help me to be able to buy health care and take my kids to the doctor?’
“We need to do something on premiums. This is crunch time, it’s time the leaders locked themselves in a room and figure out what to,” he added. “If they can’t figure out a plan, then maybe, well, you got to do some kind of short-term extension until we figure out a plan.”
A centrist group of Republican and Democratic negotiators tried to make headway toward a bipartisan deal over the Thanksgiving recess, but they also acknowledge they won’t have a finished package in time for next week’s vote. That’s deepening doubts that any agreement can be struck before year’s end.
“There are still a lot of conversations ongoing, but I think it will be difficult to get something by next week,” said Sen. Jeanne Shaheen (D-N.H.), who has been heavily involved in the talks.
Shaheen said she’s been in contact with House lawmakers and that even if the Senate does pass a bill, she’s hearing that Speaker Mike Johnson (R-La.) is unlikely to put it on the House floor.
“What I’m hearing is that it’s unlikely that Speaker Johnson will take up any bill and that it would have to be done by a discharge petition,” she said.
Some lawmakers are eyeing that rarely used maneuver — collecting 218 signatures to force a vote over the Speaker’s objections — as a potential workaround. It’s the same tactic that succeeded last month in bringing up the Epstein Files Transparency Act. But it’s considered a long shot that would require weeks or even months of organizing.
Within the Senate GOP, there’s also a deeper disagreement over strategy: whether Republicans should even try to craft a comprehensive alternative health care plan. Some warn that putting out their own proposal would invite internal divisions and hand Democrats a clear target heading into the 2026 campaign season.
Sen. John Cornyn (R-Texas), who is on the ballot next year and facing a tough primary, suggested Republicans might instead focus on bringing narrower proposals to the floor that spotlight what they see as flaws in the ACA.
“I don’t see any way under the sun that we would support extension of the current broken system,” Cornyn told reporters Wednesday, predicting that any bill to extend the enhanced ACA subsidies will fail.
Asked whether Republicans might forgo offering a single, unified alternative altogether, Cornyn replied: “There are different ideas.”
“Republicans have always had trouble coalescing around an alternative health care proposal,” he said. “There’s some suggestion to target specific elements of the existing [law] to show its problems.”
That approach would allow GOP candidates to run next year arguing that the Obama-era health law — along with the enhanced premium subsidies signed by President Biden during the COVID-19 pandemic — is a major reason for rising insurance costs.
“If you think about what government has done, everything that they’ve done has made everything more expensive: cars, health care, housing,” Sen. Rick Scott (R-Fla.) said.
Sen. John Hoeven (R-N.D.) said he expects Senate Republicans will eventually bring some kind of alternative to the floor, at least to give their colleagues political cover if they vote against the Democratic extension.
“They’ll probably put up their three-year extension” of the subsidies, he said. “We’ll put something up, too. It would be my expectation at that point you might not pass either one, and then we’ll go back to work.”
Hoeven said Republicans want to emphasize their backing for more federal support for health savings accounts to help consumers manage out-of-pocket costs, along with changes to the ACA marketplaces that would require lower-income enrollees to contribute something toward their coverage.
“We recognize that we want to get something in place soon because of the impact right now of those premium increases,” he said.
Senate Democratic Leader Chuck Schumer (N.Y.) has not yet formally rolled out the Democratic proposal that will reach the floor next week, but Democratic aides expect it to be a three-year extension of the ACA subsidies, mirroring a bill House Democrats are already backing.
Senate Majority Leader John Thune (R-S.D.) said Wednesday that how Republicans respond will depend heavily on how that Democratic bill is structured.
Thune said there’s wide GOP support for allowing self-employed workers and small businesses to band together in “association coverage” to negotiate better rates, or to buy into plans offered by large retailers like Costco and Walmart across state lines.
“Buying across state lines, allowing people to join larger groups — to get into the group market out of the individual market … that is a way that you could significantly address the issue of cost and affordability,” he said. “That would be a part of anything we do. Obviously some of that would take a little time to implement.”
