The U.S. Senate returned to square one on national healthcare legislation Thursday after both competing proposals aimed at addressing a huge spike in insurance costs failed to secure the necessary votes, leaving millions of Americans facing a virtual certainty that enhanced Affordable Care Act (ACA) tax credits will lapse at the end of the year.
With only a matter of days remaining before the credits expire, lawmakers failed to bridge the partisan divide, pushing the crisis—which was the focal point of the recent record government shutdown—to the brink.
Both dueling measures failed in 51-48 procedural votes, falling well short of the 60 votes required to advance. The enhanced ACA subsidies, which help lower or eliminate out-of-pocket costs for monthly premiums purchased through the marketplace, are set to expire, which will cause prices to skyrocket for tens of millions of people.
The Democratic proposal sought a three-year extension of the enhanced ACA subsidies. In a sign of the bipartisan concern over the looming price hikes, four Republicans—Senators Susan Collins (Maine), Josh Hawley (Missouri), Lisa Murkowski (Alaska), and Dan Sullivan (Alaska)—voted with all Democrats in support of the measure.
The Republican-backed plan, authored by Senators Bill Cassidy (R-LA) and Mike Crapo (R-ID), failed with only one Republican, Sen. Rand Paul (R-KY), opposing it. This plan would have done away with the enhanced tax credits, instead diverting the funds into Health Savings Accounts (HSAs) for individuals purchasing bronze-level or “catastrophic” plans on the ACA exchanges. Democrats rejected the bill, arguing it did nothing to address health care premiums.
The votes were quickly followed by mutual recriminations. Senate Minority Leader Chuck Schumer (D-NY) declared, “After today’s vote, the American health care crisis is now 100% on Republican shoulders,” stressing that Republicans have not been willing to find a satisfying compromise.
Senate Health Committee Chairman Bill Cassidy (R-LA) issued a statement slamming Schumer’s side of the aisle: “Democrats need to stop playing politics with people’s health care and come to the table to find real solutions.”
With the clock ticking toward the Dec. 31 expiration, attention now turns to the executive branch and President Donald Trump, who has been “missing in this whole effort,” according to Schumer.
White House press secretary Karoline Leavitt confirmed on Thursday that President Trump is “prepared to take action on healthcare” and wants Republicans on the Hill to do the same. Leavitt added that the public will “hear more from the president and from the White House on that very soon as for wanting a solution to lower health care costs.”
While the administration has yet to release a specific proposal, President Trump has previously suggested giving money directly to Americans to pay for their health care coverage.
Though Senate Majority Leader John Thune (R-SD) reiterated the GOP’s desire for ACA reforms, the narrow window for a deal is closing rapidly. Some lawmakers are exploring a “hybrid approach” that might combine a temporary extension of ACA subsidies with measures to lower patient deductibles, hoping the crossover votes signal a path forward.