Trump has remained on the sidelines of the health care debate as intra-GOP divisions over the future of Obamacare persist.
Senate Republicans and Democrats predictably failed to advance their respective party-line health care proposals on Thursday, continuing the standoff over the future of Obamacare that’s gripped Congress in recent weeks. The failed votes mean that, barring a bipartisan miracle over the next few days, the controversial enhanced Affordable Care Act subsidies are all but guaranteed to expire on December 31.
A procedural vote to advance a Health Savings Account-centered health care bill authored by GOP Senators Bill Cassidy (La.) and Mike Crapo (Idaho) failed in a 51-to-48 vote. Libertarian-leaning Republican Senator Rand Paul (Ky.) cast the only GOP “no” vote while GOP Senator Steve Daines (Mont.) was absent.
The bill would direct the Department of Health and Human Services to put as much as $1,500 into “HSAs paired with bronze or catastrophic plans on the Obamacare exchanges in 2026 and 2027,” according to a readout of the legislation. The GOP leadership-backed bill would not cover gender-transition or abortion procedures and would not extend the controversial enhanced Affordable Care Act subsidies, which were created by Democrats and are set to expire at the end of the month.
Senate GOP leaders have spent recent weeks accusing their Democratic colleagues of refusing to negotiate in good faith. “When we get through this exercise this week the question is, ‘Are there enough Democrats who want to fix the problem?’” Senate Majority Leader John Thune (R., S.D) told reporters Wednesday. “Obviously we don’t have a lot of time to do this, but I think there are ways in which you could, where there’s a will.”
Also on Thursday, Senate Democrats failed to advance their clean three-year extension of the ACA subsidies in 51-to-48 vote. Republican Senators Lisa Murkowski and Dan Sullivan of Alaska, Josh Hawley of Missouri, and Susan Collins of Maine joined a united Democrat caucus in backing the legislation.
Senate Republicans’ failure to advance the Cassidy-Crapo plan on Thursday came after nearly a half-dozen GOP-drafted proposals circulated on the hill from Senators Jon Husted (R., Ohio), Rick Scott (R., Fla.), and Roger Marshall (R., Kan.), along with a joint proposal authored by Bernie Moreno (R., Ohio) and Susan Collins (R., Maine). Marshall, Husted, and Collins are up for reelection in 2026.
Many congressional Republicans are staunchly opposed to extending the enhanced ACA subsidies in any form — even with income caps and other reforms — on the grounds that they were created by Democrats, were originally sold as temporary, and are rife with fraud. And yet other congressional Republicans believe that the GOP should support a temporary extension of the subsidies with phaseouts over time; they fear that letting the subsidies lapse will spell electoral disaster for the GOP in 2026.
President Donald Trump has largely delegated the health care fight to congressional GOP leaders. He told reporters aboard Air Force One earlier this week that he “likes the concept” of the Cassidy-Crapo proposal. “I love the idea of money going directly people, not to the insurance companies, it can be in the health savings accounts, it can be in a couple of different ways,” Trump said, stopping short of a full-throated endorsement of the legislation.
House Republican leaders plan to unveil in the coming days their own health care plan, which is not expected to include an extension of the enhanced ACA subsidies. The details remain unclear. But according to news reports, GOP leaders presented House Republican members with a menu of different health care ideas during a closed-door meeting on Wednesday. The presentation reportedly included a slide with ten different proposals, including “association health plans,” “choice accounts,” “health savings accounts,” “cost sharing reductions, codifying “Trump administration rules to fix Unaffordable Care Act,” “PBM reform,” “innovation,” “price transparency,” “site neutrality,” and “provider-owned hospitals.”
Furious that Speaker Mike Johnson isn’t prioritizing an extension of the subsidies, some House Republicans are circumventing leadership.
A bipartisan cohort of moderate House members — including GOP Representative Brian Fitzpatrick of Pennsylvania and Jared Golden of Maine — are circulating a discharge petition to force a floor vote on a bill that would extend the subsidies with some reforms. Another bipartisan group of House centrists led by Josh Gottheimer of New Jersey is circulating a separate subsidy-focused discharge petition as well.
Both efforts face steep odds to passage. Discharge petitions require 218 signatories to trigger a floor vote and 218 votes to advance to the Senate. Both outcomes will be difficult for centrist co-sponsors to achieve given the divisions on health care and the GOP’s slim margin.
“It’s a time-sensitive matter, and it’s an existential matter,” Fitzpatrick told reporters this week. “You try to do things through the normal course. You try to do things through regular order.” And when “all those remedies are exhausted,” he added, “then you’ve got to go this route, unfortunately.”
Thune is prioritizing Senate action while keeping his options open regarding House-drafted legislation.
“We’ll cross that bridge when we come to it,” he told reporters. “If someone is successful in getting a discharge petition out of the House, then we obviously we will take a look at it.”
Another major sticking point in the health care subsidy debate is the Hyde Amendment. Taxpayer funding of abortion was one of the biggest concerns on Capitol Hill when Congress debated the Affordable Care Act more than 15 years ago, and pro-life groups have maintained for years that the legislation allows loopholes for elective abortion coverage in some states. Now, Democrats are refusing to consider any bipartisan subsidy-extension proposals that includes Hyde Amendment protections.
“What I think is kind of interesting is the Democrats continue to be dismissive about Hyde protections, because they say they’re effectively in there,” Senator Thom Tillis (R., N.C.) told NR earlier this week. “If they’re interested in actually extending the subsidies, if they’re effectively in there, then why should they worry about us putting language in that assures that?”