The U.S. Senate failed to advance two competing health care proposals on Thursday, leaving millions of Americans possibly facing steep insurance premium hikes when enhanced Affordable Care Act (ACA) subsidies expire at year’s end.
Both parties offered plans aimed at averting those increases, but neither secured the 60 votes needed to overcome a filibuster. The Republican measure, the Health Care Freedom for Patients Act of 2025, co-sponsored by Sens. Bill Cassidy and Mike Crapo, would have allowed the COVID-era subsidies to sunset on the timeline Democrats originally set. Instead of continuing tax credits to insurers, the bill would have redirected federal funds into health savings accounts (HSAs): $1,000 for adults ages 18–49 and $1,500 for those 50–64, capped at 700% of the federal poverty level. The proposal also would have expanded eligibility for catastrophic plans and restricted federal funds from being used for abortion or gender transition services. Republicans argued the plan sends money “back to patients” rather than insurance companies. Still, it failed 51–48.
The Democrat-backed proposal, the Lower Health Care Costs Act, sought a three-year extension of the enhanced ACA subsidies created during the pandemic, at an estimated cost of $83 billion. Democrats warned that without renewal, premiums could double for many families and that the expiring subsidies were crucial to keeping coverage affordable. Republicans countered that claims of widespread doubling were misleading, noting that most enrollees would continue receiving the original ACA subsidies and that only about 1.6 million people would lose enhanced credits entirely.
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With both bills blocked in the Senate, millions nationwide are expected to face higher premiums. According to KFF, those losing enhanced support could see increases ranging from several hundred dollars to more than $1,500 per person. University of Montana economist Katrina Mullan warned that lower-income individuals not eligible for Medicaid and older adults not yet on Medicare will feel the sharpest impacts. Rising premiums may also push healthier people out of the market, potentially driving costs higher for those who remain insured.
Kentucky GOP Sen. Rand Paul, the only Republican to vote against the GOP bill, has his own plan, which he said was not a “watered-down version” of Obamacare.
“My plan actually fixes the system. It doesn’t cost taxpayers a dime, and it finally frees Americans to buy insurance across state lines through real co-ops. No bureaucracy, no bloated mandates – just competition, choice, and lower costs,” Paul said. “Basically I would legalize the ability to buy insurance across state lines, through a co-op.”
Despite the Senate stalemate, House lawmakers may pursue their own measure, while Republicans continue developing alternative plans, including broader HSA-based proposals and bills to expand insurance competition across state lines.
