Senate Filibuster Derails Dual Efforts to Prevent Massive ACA Premium Increases

On Thursday, two versions of legislation aimed at addressing a looming premium rate hike for participants on the Affordable Care Act’s (ACA) marketplaces — one offered by Democrats, the other by Republicans — were blocked by Senate filibusters.

During the pandemic, tax credits were offered to qualifying individuals and families to allow more access to the marketplaces. Those credits are set to expire at the end of this month, and will result in a 114 percent increase in premiums, on average, for around 22 million Americans. Polling indicates that many of the people affected by the increases will consider not purchasing insurance at all as a result.

In the months leading up to this crisis, the Trump administration and Republicans in Congress refused to address it — extensions on the tax credits were not part of President Donald Trump’s “One Big Beautiful Bill” Act, for example, and GOP lawmakers refused to negotiate with Democrats on renewing the credits during the government shutdown.

As part of a handshake agreement to end the shutdown, Republicans in the Senate allowed an up-or-down vote on extending the ACA tax credits. The bill received majority support — 51 senators (including four Republicans) backed the legislation, against 48 who opposed — but the filibuster blocked its advancement.

A Republican bill also obtained majority support — 51 Republican senators voted for their plan, while 48 senators (all Democrats plus one Republican) voted against it.

While the Democrats’ bill would have renewed the tax credits, Republicans offered a different path: providing recipients of the credits with health savings accounts (HSAs) instead, with most receiving somewhere between $1,000 to $1,500 in tax-free accounts to spend on health care costs rather than having tax credits go directly toward their insurance premiums.

Senate Minority Leader Chuck Schumer (D-New York) condemned the GOP plan.

“The Republican bill is little more than junk insurance. It is no real plan at all,” Schumer said in a Senate floor speech.

Republicans defended their inability to coalesce around one of the two bills — and indeed, other competing proposals within their conference.

“The challenge Republicans have always had is trying to unify behind a single proposal. We’ve just got too many good ideas,” Sen. John Cornyn (R-Texas) said.

Critics disagree with that assessment.

“The Republican counterproposals are all over the place,” said Cynthia Cox, director of the ACA program at KFF. “They span a really wide range here that is probably representing how fragmented Republicans are on health insurance issues more broadly.”

Early last month, Gideon Lukens and Elizabeth Zhang from the Center on Budget and Policy Priorities wrote a joint op-ed on the subject, saying the best path forward was to renew the tax credits and extend the period for enrollment.

The duo called on Congress to “minimize the number who are left uninsured by extending the enhancements as soon as possible,” and to “extend the open enrollment period” beyond January 15, in recognition of people having “experienced sticker shock” from higher than expected costs, and “to give people more time to sign up” for the program.

Lukens and Zhang added:

If Congress allows the premium tax credit enhancements to expire, nearly all marketplace enrollees will face significantly higher premium costs, which will more than double on average, and 3.8 million more people will be uninsured in 2035. Congress should make the enhancements permanent so that families have stability and predictability when it comes to their access to affordable health insurance.

Polling also indicates that those on ACA marketplace exchanges want the tax credits extended, with a recent KFF survey showing 84 percent of participants saying as such.