Dueling GOP and Democrat health care bills fail in the Senate

Senate Republicans and Democrats once again failed to break their stalemate over the future of the Affordable Care Act on Thursday, leaving enhanced health-insurance subsidies on track to expire at the end of the month absent an unlikely bipartisan breakthrough.

Both parties attempted to advance sharply divergent health-care bills, with each side accusing the other of intransigence. Each proposal failed in a 51–48 procedural vote, underscoring the depth of the disagreement and the shrinking timeline before millions of Americans could see their insurance costs spike on January 1.

GOP HSA-Centered Plan Falls Short

Republicans first tried to move forward on a bill crafted by Senators Bill Cassidy of Louisiana and Mike Crapo of Idaho. The legislation, built around expanded Health Savings Accounts, would direct the Department of Health and Human Services to deposit up to $1,500 into HSAs paired with bronze or catastrophic Obamacare plans in 2026 and 2027. It also explicitly excludes coverage for abortion and gender-transition procedures and would let the ACA subsidy enhancements expire as scheduled.

The vote failed narrowly after Senator Rand Paul, a Kentucky Republican known for his libertarian leanings, broke with his party to vote “no.” Senator Steve Daines of Montana was absent.

Republican leaders have spent weeks accusing Democrats of refusing to negotiate on any plan that does not extend the enhanced subsidies. Ahead of the vote, Senate Majority Leader John Thune said the question after this week would be whether “there are enough Democrats who want to fix the problem,” adding, “we don’t have a lot of time to do this.”

The Cassidy–Crapo bill was only the most prominent of nearly half a dozen GOP ideas circulating in recent weeks from figures including Senators Jon Husted, Rick Scott, Roger Marshall, Bernie Moreno, and Susan Collins — the latter three of whom face reelection battles in 2026.

Democrats’ Clean Subsidy Extension Also Blocked

Democrats fared no better. Their proposal to pass a simple three-year extension of the enhanced subsidies also failed 51–48. Four Republicans — Senators Lisa Murkowski and Dan Sullivan of Alaska, Josh Hawley of Missouri, and Susan Collins of Maine — joined Democrats in supporting the measure.

The Democratic approach leaves the current subsidy structure unchanged, which Republicans have criticized as fiscally irresponsible and subject to fraud. Many in the GOP also note that the subsidies were originally pitched as temporary and argue that making them long-term, even with reforms, would reward what they view as a flawed system.

Yet other Republicans fear the political consequences of allowing the subsidies to lapse in an election cycle. Some warn the party could pay a steep price in battleground states in 2026 if out-of-pocket costs suddenly rise for millions of consumers.

Trump Signals Openness but Stops Short of Endorsement

President Donald Trump, who has largely delegated the fight to congressional Republicans, told reporters this week that he “likes the concept” of the Cassidy–Crapo model and that he loves the idea of money going “directly to people,” including through HSAs. He did not fully endorse the bill.

House GOP Eyes Its Own Plan — While Moderates Revolt

House Republican leaders are preparing to introduce their own health-care proposal in the coming days. Early indications suggest it will not continue the enhanced subsidies. Members were recently shown a menu of options that included association health plans, HSAs, price-transparency reforms, site-neutral payment rules, PBM reforms, and other market-driven changes.

But some House Republicans are openly rebelling.

A bipartisan group led by GOP Representative Brian Fitzpatrick and Democrat Jared Golden is circulating a discharge petition aimed at forcing a vote on a subsidy-extension bill with reforms. A separate, similar petition is being circulated by Representative Josh Gottheimer. Both measures face long odds, given the GOP’s narrow majority and the 218 signatures required.

Fitzpatrick called the situation “a time-sensitive matter, and … an existential matter,” noting that lawmakers typically try regular order first — and only resort to discharge petitions when “all those remedies are exhausted.”

Thune, asked about the House efforts, said, “We’ll cross that bridge when we come to it,” adding that Senate leaders would consider a House-passed bill if one emerged from a successful petition.

Abortion Restrictions Emerge as a Major Roadblock

Another obstacle is the long-running battle over whether the ACA permits federal subsidies to support plans that cover abortion. Republicans have pushed for adding explicit Hyde Amendment protections to any new subsidy extension, while Democrats insist they won’t consider proposals that include such language.

Senator Thom Tillis argued this week that Democrats are being inconsistent — noting their claim that Hyde protections already effectively apply. If that’s true, he said, they shouldn’t object to “putting language in that assures that.”

Clock Ticking Toward Dec. 31

With both partisan plans rejected and negotiations showing little progress, the enhanced subsidies appear almost certain to lapse at year’s end. The expiration would mark a major shift in the post-pandemic health-insurance landscape and potentially raise premiums for millions of families who rely on ACA marketplace coverage.

Barring an unexpected agreement between the chambers — or a successful revolt by House centrists — the political and financial consequences of the subsidy fight will arrive swiftly in January, with an election year looming not far behind.