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Trump and Republicans Once More Face a Tough Political Fight over Obama-Era Health Law

The Senate debates extending expiring Affordable Care Act subsidies or redirecting funds to health savings accounts as millions face premium hikes, with a vote expected by mid-December.

  • By mid-December, the U.S. Senate is expected to vote on expiring ACA subsidies after Senate Majority Leader John Thune, R-S.D., promised a vote tied to the deal to reopen the government.
  • With premiums set to rise in less than six weeks, roughly one-third of ACA marketplace enrollees rely on enhanced subsidies, affecting millions of Americans.
  • Sen. Bill Cassidy proposes redirecting subsidy dollars into expanded Health Savings Accounts, citing the 2025 GOP reconciliation law's reclassification of bronze plans and illustrating with a hypothetical woman who "can spend on her physician, her dental care, her prescriptions," Cassidy said.
  • Senate Democrats insist a clean extension of COVID-era subsidies is the `bare minimum`, led by Ron Wyden, the Finance panel's ranking member, D‑Ore., amid highly partisan competing health-affordability bills.
  • Implementing any overhaul would take months or years, requiring new information technology systems and rulemaking, while some House Republicans see merit in the HSA idea but say it isn't ready for plan year 2026.
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Issues & Insights broke the news in on Wednesday, November 19, 2025.
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