Congress Left Without a Health Care Deal. What Comes Next?

Congress left the year without reaching a deal on health care, letting Affordable Care Act subsidies that helped lower insurance prices for about 22 million Americans expire Dec. 31 without taking steps to address the soaring costs expected to follow.

As the end of the subsidies approaches, American families and individuals are bracing for the immediate consequences. Monthly payments for millions of ACA Marketplace subscribers are expected to double or even triple without the tax credits that have made their premiums cheaper. The Congressional Budget Office has estimated that the failure could leave about 4 million more Americans uninsured, with analysts warning of broader consequences in coming years.

The enhanced subsidies were introduced during the COVID-19 pandemic and extended by Democrats in 2022. For many low-income Americans, they resulted in free or nearly free coverage. For beneficiaries with higher incomes, premiums have been significantly reduced. Lower costs have contributed to a surge in enrollment, particularly among Americans in Republican-led Southern states, where coverage previously lagged.

Learn more: What the end of Obamacare subsidies could mean for your health coverage

Democrats have been pushing for months to further extend the subsidies, making them a key demand in the spending impasse that paralyzed the government this fall. A group of Democratic senators ultimately broke with the party to reopen the government on the condition that a vote on an extension measure take place in December. But lawmakers have now left Washington without holding one.

Four swing district House Republicans defied party leadership and joined a Democratic-led discharge petition to force a vote on a three-year extension in the House. President Mike Johnson, who refused to put the issue to a vote before the recess, will have to do so after Congress resumes in the new year. The vote is expected the week of Jan. 5, when the House returns to session.

Even if the bill passes the House when it votes next month, Senate Republicans will likely block it, as they did with a similar Democratic proposal earlier this month. But some lawmakers expressed hope that it could help them move closer to passing a health care bill.

“I believe that if the bill is introduced, not only will it pass, but it will give the Senate the opportunity to come back with a bipartisan compromise and pass something into law,” Rep. Mike Lawler of New York, one of the Republicans who signed the discharge petition, said Wednesday on NBC’s “Meet The Press Now.”

Republican Sen. Susan Collins of Maine told NBC News that the House’s passage of the bill would “keep the momentum going” but declined to express support.

“What we’re trying to do is put together a bipartisan bill that would have reforms and a two-year extension,” Collins said. “This is the best approach, in my opinion, and we are making good progress.”

Appearing on ABC’s “This Week” with Jonathan Karl, House Minority Leader Hakeem Jeffries brushed off comments from Senate Majority Leader John Thune, who said a three-year extension would be dead on arrival in the Senate. Jeffries said Thune “does not take protecting the health care of the American people seriously.”

“It will pass, with a bipartisan majority, and that will then put pressure on John Thune and Senate Republicans to do the right thing for the American people: pass a simple expansion of the Affordable Care Act tax credits so that we can keep health care affordable for tens of millions of Americans who deserve to be able to see a doctor when they need it,” Jeffries said.

Republican Sen. Rand Paul of Kentucky, meanwhile, said Sunday that he remained opposed to expanding subsidies, instead favoring an alternative health care proposal centered on expanding association health plans, which would allow consumers to band together to negotiate lower insurance premiums.

Paul, earlier this month, was the only Republican senator to vote against a GOP proposal to establish government-funded health savings accounts.

“We have health care in our country for poor people. It’s called Medicaid. Everything else hasn’t worked,” Paul said in an interview with ABC’s Jonathan Karl. “Obamacare has been a failure. President Obama said he would cut premiums; premiums have exploded. Every time we give more subsidies, premiums go up.”

A Republican proposal passed by the House on Wednesday, which does not include an extension of the subsidies, also appears unlikely to gain success in the Senate. “I would expect that the vote count, if it was all about that, probably wouldn’t be the same as it was last week,” Sen. Thom Tillis, Republican of North Carolina, told NBC News, appearing to refer to the failure of a separate GOP bill in the Senate.

Meanwhile, subsidies are expected to return to pre-pandemic levels before Congress returns, leaving millions facing steep premium increases. And amid the anticipated price changes, the ACA Marketplace open enrollment deadline for the year is fast approaching, January 15. Experts have suggested some options for Americans to consider as they look for ways to keep their coverage more affordable.

Learn more: Where Obamacare’s price hike could hit hardest next year

Each party has pointed the finger at the other over rising health care prices. President Donald Trump delivered a 20-minute speech Wednesday in which he blamed Democrats for high costs while saying his administration’s policies offered relief. “It’s the Unaffordable Care Act,” he said. “The Democrats are responsible.”

Congressional Democrats, meanwhile, are accusing their Republican counterparts of failing to take action as the ACA subsidies’ expiration date approaches.

“Republicans still have a chance to cut health care costs. But they still seem determined not to do it,” said Democratic Sen. Elizabeth Warren of Massachusetts. Semafor.

Another deadline is also looming in the new year: The short-term spending bill passed by Congress in November, reopening the government, will only fund the government through Jan. 30, meaning it will be shut down again if lawmakers don’t reach an agreement by that date.

Trump told a crowd of supporters at a rally in North Carolina on Friday that Democrats were going to “shut down the government” again, accusing them of being “indebted” to insurance companies.

Senate Minority Leader Chuck Schumer, however, insisted that Democrats would not tie a spending bill to renewed subsidies in the new year.

Talk to Punchbowl NewsSchumer noted that Obamacare’s enhanced subsidies will have expired by Jan. 30 and said Republicans have shown they are incapable of reaching a bipartisan deal. He added that Democrats believe they have succeeded in making health care a priority issue for voters next November.