Enhanced ACA Health Subsidies Nearing Expiry as Congress Remains Divided\n\n## Introduction\n\nEnhanced Affordable Care Act (ACA) health insurance subsidies are scheduled to expire at the end of the current year. This expiration is projected to result in increased premiums for millions of Americans enrolled in ACA marketplace plans. Despite the approaching holiday recess, members of Congress are anticipated to depart Washington without having extended these subsidies.\n\nThe deadline for enrolling in ACA exchange plans recently passed. Some subscribers have indicated they may forgo health insurance due to affordability concerns without the continuation of these subsidies.\n\n## Legislative Landscape and Proposals\n\nEfforts by bipartisan groups in both the House and Senate to advance measures extending the subsidies, potentially with additional reforms, have not yet secured widespread support. Only partisan proposals have been brought to a vote so far, with measures backed by Senate Republicans and Senate Democrats each failing to garner sufficient votes.\n\nThe House is expected to vote on a health reform package introduced by Speaker Mike Johnson (R-La.). This proposal includes conservative-favored ideas, such as association health plans, but does not incorporate an extension of the expiring ACA subsidies.\n\nHouse Democrats have continued to advocate for a standalone three-year extension of the subsidies, without additional reforms. In the Senate, four Republicans—Susan Collins (Maine), Lisa Murkowski (Alaska), Dan Sullivan (Alaska), and Josh Hawley (Missouri)—voted with Democrats on a bill to extend the subsidies, citing the impact on constituents' health care costs.\n\n## Perspectives on Subsidy Extension\n\n### Support for Extension\n\nDemocrats have actively sought to compel an extension of the subsidies, employing various legislative strategies, including actions that led to a government shutdown.\n\nSome Republicans, such as Rep. Kevin Kiley (R-Calif.), have expressed concern regarding the impact of subsidy expiration on individuals, including small business owners, independent contractors, and early retirees. Approximately a dozen House Republicans have supported proposals to force a vote on extending the subsidies, though the likelihood of passage before expiration remains uncertain. Rep. Marjorie Taylor Greene (R-Ga.), despite historical criticism of the ACA, has also called for retaining the subsidies, highlighting health care costs as a significant issue in her district.\n\nSurveys indicate broad public support for extending the enhanced subsidies across the political spectrum. Data suggests that over half of ACA marketplace enrollees reside in Republican congressional districts, encompassing demographics such as rural residents, small business owners, and farmers. A poll conducted in competitive congressional districts also showed widespread support for the extension.\n\n### Opposition and Alternatives\n\nSome Republicans, including Sen. Bill Cassidy (R-La.), a gastroenterologist who helped develop the failed Senate GOP health plan, have characterized the ACA as the "Unaffordable Care Act" and argue that subsidies primarily benefit insurance companies. Cassidy's proposed plan included depositing up to $1,500 annually into health savings accounts for eligible individuals with high-deductible ACA plans, which could be used for expenses other than premiums.\n\nHouse Republican leadership reportedly prevented efforts by moderate members to add a vote on extending the subsidies to the GOP health bill. Former President Trump has maintained criticism of Obamacare and has not endorsed an extension of the subsidies.\n\nSpeaker Johnson has articulated a shift in Republican strategy from "Repeal and Replace" the ACA to "Reduce and Repair" it, acknowledging its extensive integration into the healthcare system. However, specific concrete reforms from Johnson and other Republicans have been in development.\n\n## Historical Context and Political Implications\n\nThe passage of the ACA in 2010 without Republican votes initiated long-running legislative conflicts, including a government shutdown in 2013. Former Republican House Majority Leader Eric Cantor stated that opposition to the law contributed to the emergence of the Tea Party and later the Make America Great Again movement.\n\nDespite repeated attempts by Republicans to repeal and replace Obamacare, many now recognize its enduring presence. Former Rep. Fred Upton (R-Mich.) noted the absence of a viable alternative after 15 years.\n\nDemocrats utilized health care as a central campaign issue in the 2018 midterms, a factor contributing to their regaining control of the House. Examples include Andy Kim (New Jersey) and Elissa Slotkin (Michigan), whose campaigns focused on health care access and pre-existing conditions. Both now serve in the Senate.\n\nThe popularity of the ACA has increased over time, with recent polling indicating greater favorability than when it was first enacted. A Democratic committee staffer from 2018 attributed this shift, in part, to Republican efforts to dismantle the law, which, she suggested, helped Americans understand its benefits. Democrats anticipate that congressional inaction on extending subsidies will be a key campaign issue in upcoming elections, positing that rising health care costs are a significant personal concern for voters.\n\n## Outlook\n\nThe House is scheduled to vote on Speaker Johnson's health care bill, which does not address the subsidies. Some lawmakers express hope that the failed partisan votes might encourage renewed efforts toward a bipartisan compromise. However, with lawmakers set to recess soon and new premium rates for ACA plans approaching within two weeks, the timeframe for a legislative solution to prevent premium increases is limited.