Republicans are running out of time to make decisions on health care

This week, Republican leaders are back at Capitol Hill under pressure to decide the fate of Affordable Care Act (ACA) subsidies, with the year-end deadline fast approaching. The party remains divided on whether to extend benefits for millions of Americans or let them expire as scheduled.

The debate highlights a tension within the GOP: moderates seeking affordability measures ahead of the 2026 midterms versus conservatives who oppose ObamaCare as excessive government intervention. Centrist Republicans in vulnerable districts are advocating for maintaining the subsidies, while others insist the enhanced tax credits, enacted during the COVID-19 pandemic, should end on January 1.

Speaker Mike Johnson (R-La.) and GOP leaders face a difficult choice. Extending the subsidies risks endorsing a law many conservatives view as harmful, while failing to extend them could sharply increase health care costs for over 20 million Americans just before next years elections. Some warn that inaction could jeopardize the House majority.

Last week, President Trump reportedly planned a two-year extension of the subsidies, with additional eligibility restrictions aimed at protecting vulnerable Republicans during elections while exploring a market-based solution. However, conservative backlash forced the White House to abandon the proposal, with Johnson himself reportedly advising reconsideration.

Meanwhile, centrist Republicans in the Problem Solvers Caucus have collaborated with Democrats on legislation extending the subsidies for two years. Rep. Jen Kiggans (R-Va.) has proposed a separate one-year extension, supported by 14 other GOP lawmakers. Other proposals are expected as Republicans try to prevent a financial cliff.

After Thanksgiving, members of the Problem Solvers Caucus plan to introduce yet another temporary subsidy extension, setting up a confrontation with conservative colleagues. Lawmakers previously convened at Paccis Italian restaurant near Capitol Hill to devise a plan with broad Republican support, according to Rep. Brian Fitzpatrick (R-Pa.).

Fitzpatrick noted efforts are underway to present legislation after the recess, aiming for a bipartisan approach, although the starting point must focus on Republicans since ACA provisions originated from Democrats.

Senate Majority Leader John Thune (R-S.D.) indicated that a vote on extending health care subsidies could be tied to ending the government shutdown, but GOP backing remains uncertain, and a House vote is not guaranteed. Trump recently stated he prefers direct payments to patients over subsidy extensions, though he acknowledged a short-term extension might be necessary.

Moderate Republicans are pushing to extend enhanced subsidies, while other GOP proposals suggest reallocating funds. Sen. Bill Cassidy (R-La.) supports using subsidy funds for Health Savings Accounts (HSAs) for high-deductible plans, while Sen. Rick Scott (R-Fla.) proposed Health Freedom Accounts funded by ACA subsidies, marking a significant potential overhaul.

Speaker Johnson told The Hill that Republicans plan to release a health care proposal in early December. House Majority Leader Steve Scalise (R-La.) is coordinating with key committee chairs to finalize a GOP plan focused on reducing costs while maintaining quality and access. Some conservative priorities, like restricting subsidies from covering abortion-related plans, may limit Democratic support.

Rep. Mike Flood (R-Neb.), chair of the Republican Main Street Caucus, expressed support for Trumps effort to address the ACA subsidy cliff, provided reforms like income caps are included. In contrast, the Republican Study Committee opposes extending what they call wasteful COVID-era subsidies.

Democrats are pursuing a discharge petition to extend current subsidies for three years, which would extend past the 2028 presidential election. Sponsored by House Minority Leader Hakeem Jeffries (D-N.Y.), the petition has broad Democratic support but no Republican backing.

Some conservatives have voiced frustration that Trumps proposed two-year extension was dropped before formal discussion. Rep. Tim Burchett (R-Tenn.) noted that despite objections, the proposal represented action after years of inaction on ACA reforms.

Author: Sophia Brooks