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The NPR Politics Podcast
Health Insurance Subsidies Expire This Month But Congress Can't Agree On A Fix
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Tamara Keith
Hey there, it's Tamara Keith. And real quick, before we start the show, I want to take a minute to talk about public media. It's what makes the NPR Politics Podcast and other NPR podcasts special. Public Media was founded to inform, to educate, to expand our perspective. But as of this fall, federal funding for public media, including NPR and local NPR stations, has been eliminated. Despite that, we remain committed to this work to give you the context and analysis you need to make sense of the news coming out of Washington. This year alone, we've covered President Trump's second term from every angle, reshaping the federal government, launching a global trade war, an immigration crackdown in US Cities, and so much more. You can help us keep this work going in 2026. Thank you. If you already go the extra mile as an NPR supporter. If not, you can join the PLUS community. Get a bunch of perks like bonus episodes and more from NPR's podcasts. And you'll be supporting Public Media by signing up for NPR today. Just go to plus.npr.org.
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Selena Simmons Duffin
Hi, this is Kevin Francisco in Fort George, Meade, Maryland. I am minutes away from starting my retirement ceremony after serving 20 years in the Air Force.
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Sarah McCammon
This podcast was recorded at 12:36pm Eastern Time on Thursday, December 11, 2025.
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Selena Simmons Duffin
Things may have changed by the time you hear this, but I would have hopefully made the successful transition from Master Sergeant Francisco to Mr. Francisco. Okay, here's the show.
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Sarah McCammon
Congratulations and thank you for your service.
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Deirdre Walsh
Yes, thank you for your service. Onward and upward.
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Sarah McCammon
Hey there. It's the NPR Politics podcast. I'm Sarah McCammon. I cover politics.
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Deirdre Walsh
And I'm Deirdre Walsh. I cover Congress today.
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Sarah McCammon
We also have NPR health policy correspondent Selena Simmons Duffin with us. Hi, Selena.
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Selena Simmons Duffin
Hi. Thanks for having me.
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Sarah McCammon
And today on the show, many Americans will soon face much higher health insurance premiums, and unless Congress steps in, that's because enhanced subsidies that reduce those premium costs for people who buy insurance through the Affordable Care act. Marketplaces are expiring in just a couple of weeks. So, Deirdre, as of this taping, the Senate is voting on competing proposals to address this problem, one from Republicans and another from Democrats. Let's start with what Democrats want to do.
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Deirdre Walsh
They want to extend these existing enhanced Affordable Care act subsidies for three more years. The they're calling it a clean Extension. There are some other tweaks in the bill, but it basically just keeps the current subsidies going for another three years. We do not expect that to advance.
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Sarah McCammon
And what about the Republicans?
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Deirdre Walsh
So the Republican bill actually just failed to advance in the Senate. What Republicans were proposing to do, and this was a proposal from the chairman of the HELP Committee that oversees healthcare in the Senate, Bill Cassidy from Louisiana, and the Finance Committee chairman, Mike Crapo. What they want to do is not extend the subsidies that are going to expire at the end of this month, but instead basically redirect money for consumers to go into Health Savings Accounts. And it would be up to $1,500 for these HSAs for the year. Correct. And that is a proposal that they argue would give the money directly to the patient instead of the insurance companies. They argue that the current existing enhanced health care subsidies are giving too much money to the insurance companies and that this will help patients have more of a choice. That is a proposal that President Trump, in concept, has said that he likes giving money directly to consumers, but Democrats oppose it. And it did not get the 60.
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Selena Simmons Duffin
Votes it needed to advance in the Republican bill. It would take about $10 billion to put into Health Savings Accounts, and those accounts would only be for certain, like a portion of the 24 million people who use these plans. Not everybody would be eligible for them. And in the Democrats plan, the enhanced subsidies cost about $35 billion a year. And so I talked to Mark Pauly. He's a health economist at the Wharton School at the University of Pennsylvania. He mentioned that there's really a trade off that economists are there to tell people about, which is that if you pay more, you get more, but it will also cost you more.
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Deirdre Walsh
Usually politicians try to change the subject.
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Mark Pauly
By saying, well, I have a magic way that we can cut costs without having to make this trade off, whether that be Health Savings Account or whether it be Medicare for all, depending on which side of the aisle you're looking. But at least so far, there doesn't.
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Deirdre Walsh
Seem to be much evidence that there's.
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Mark Pauly
A real pixie dust that can be.
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Deirdre Walsh
Scattered over this thing.
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Sarah McCammon
And what does that mean, Selena? You know, for patients, for consumers?
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Selena Simmons Duffin
Yeah. I mean, the way that the subsidies, these enhanced subsidies worked is that you would only ever pay a certain portion of your income. So if you were low income and you wanted to select a very generous plan, then you would get a lot of money. And every single month, not directly, but towards your premium to make it really kind of affordable for you. This system, you couldn't use the thousand dollars or the fifteen hundred dollars towards your premium at all. And as you mentioned, it's per year. You know, like I talked to a woman this week who lives in West Virginia and she's looking at a $2,000 premium every month. So $1,500 a year is just like not even going to cut into that at all.
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Sarah McCammon
It also sounds like some of these ideas sort of echo what was being discussed over the summer when Congress was debating the so called one big beautiful bill, the tax and spending bill. How does this current debate compare to what happened back then?
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Selena Simmons Duffin
Yeah, I was really struck by the fact that the Republican bill included some kind of wish list items that didn't survive because it was using the reconciliation process and it had to be related to the budget. So for example, you know, this health savings account is the first part and we're going to give this much money and that's going to help people with their health costs. And then it says abortion can't be covered in these plans and gender affirming care can't be covered in these plans. Or Medicaid or chip, the Children's Health Insurance Program for anyone of any age. These are health provisions that fell out over the summer basically that they're sticking back into this bill, but as Deirdre said, it did not advance. And on the Democratic side they're trying to undo some of the provisions that affected the Affordable Care act in that bill. So for example, one of the ways that the one big beautiful bill raised money on the health side was getting rid of a cap in terms of repayment. So it's a little complicated, but basically a lot of people who buy these plans are self employed or run their own company. So they're making a guess on how much money they're going to make. They don't have a salary. Right. And so the amount of subsidy is based on your income. And if your income is a guess, then that creates kind of the situation where you might have to repay some of the subsidy. And in the old system there was a cap where you wouldn't have to pay tens of thousands of dollars if you really had a good year. You know, for example, over the summer they got rid of the cap. So I talked to a small business owner who was really concerned about this. She lives in Georgia, and she was saying like this could really like crater my income if I guess wrong.
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Deirdre Walsh
I mean, I think in the case of both of these bills, point that Selena made is these are essentially like wish lists for both parties. No one was under any illusion in the Senate that either one of these proposals was going to advance. Up until this week, Republicans weren't even sure they were going to put up a plan of their own because they're so divided about what they want to do going forward. And there are multiple Senate Republican plans. Some include a short term extension of these subsidies for one or two years. So I think the political argument a lot of Senate Republicans made was we can't just block an extension and not have a plan of our own to talk about. So I think that's sort of what we're seeing here, is this is both a messaging exercise from both parties.
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Sarah McCammon
But as we've discussed, if nothing gets done, consumers are going to feel the impact of, of these cost increases pretty soon. And we're going to talk more about that in a moment. But first, we're going to take a quick break. We'll be right back.
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Mark Pauly
This message comes from Synchrony bank, who's on your team when it comes to building a brighter tomorrow, Open a high yield savings account and start saving for a fantastic Future today. Visit Synchrony.com NPR Member FDIC. This message comes from Cook Unity. Enjoy high quality culinary masterpieces for a fraction of restaurant takeout prices. Subscriptions start as low as $11ameal. Skip deliveries. Pause or cancel anytime. Get what you're craving. Try fresh, great tasting meal delivery made by your favorite celebrity chefs. Go to cookunity.com public media or enter code public media before checkout for free. Premium meals for life terms and conditions apply. Go to cookunity.com for details.
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Sarah McCammon
And we're back. We've been talking about a fight on Capitol Hill over the Affordable Care act, health insurance subsidies, which expire in a couple of weeks. And we've been talking about the competing proposals in the Senate. Deirdre, what's happening in the House?
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Deirdre Walsh
There's a lot of talking about ideas or concepts of a plan. But there is nothing headed towards the floor right now. And we are obviously staring down this big deadline at the end of the month. House Speaker Mike Johnson surprised a lot of people last week when he said, oh, the House is gonna vote on a healthcare bill because they didn't have agreement within the Republican conference on a health care bill, just like we've seen in the Senate Republican conference. So what he's done is said here are a bunch of ideas, including the approach that the Senate Republicans took with the health savings accounts and some other ideas about association health care plans, reforms for hospitals, reforms for prescription drug distribution. These are all sort of a bunch of different healthcare ideas. And he said, we're gonna talk about it and then we're gonna move forward and vote on some of these things. But it's really unclear what the substance of the bill that the House will ultimately vote on or when that vote is going to happen. Congress is in session this week and next week, but then it takes a recess for the holidays and doesn't come back till January, obviously. And in that time period, these subsidies are going to expire. Congress doesn't do big things like health care bills in the span of a couple weeks. So it's very unlikely that we're going to see anything. The other thing that's happening in the House is that a bunch of House Republicans who represent competitive districts are very upset that the speaker is not talking about any type of extension one year, two year, three year, anything for the ACA subsidies, and they have instead rolled out their own proposals. One bipartisan group has a one year extension with some reforms in year two. Another bill has a two year extension with some other reforms and expanded health care savings accounts. And what these swing district Republicans have done is they've used a process that is pretty rarely used, but in this Congress it has been used effectively. And that is filing what's called a discharge petition to force a vote on the House floor. If you get 218 signatures, which is a majority of the members of the House to sign this petition, it forces the issue and it forces a vote on the House floor. There is a bunch of procedural stuff that has to happen in terms of timing, so there isn't enough time to force that vote ahead of the expiration of these subsidies. But there are enough Republicans, if Democrats decided to join them, to force a vote on the House floor. And we don't know whether Democrats are going to do that because the position of the House Democrats right now is they are insisting on a three year extension of these existing ACA subsidies.
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Sarah McCammon
Republicans would potentially support this move, right, Deirdre? Because they're so concerned, at least some of these lawmakers are, about how this is going to hit their constituents.
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Deirdre Walsh
They are publicly warning that so many constituents in their districts aren't going to be able to afford health care and will lose their coverage and that politically this is a bad issue for the Republican Party when the central issue that is animating voters right now is affordability. And a lot of these Republicans I've talked to say at the top of the list is how unaffordable health care is. And if we make it even more unaffordable by forcing millions of Americans, many of which reside in red states and red districts, to pay these skyrocketing premiums starting in January, there will be a political backlash.
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Sarah McCammon
Selena, there appears to be no direct path to getting something done here. If Congress does nothing and these premiums hit in a couple of weeks, what is the impact? I mean, how many people are we talking about that are facing these higher premiums?
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Selena Simmons Duffin
Yeah, I mean, it's going to affect a lot of people. 24 million people, as I mentioned, are enrolled in these plans and 22 million of them were benefiting from the enhanced premium subsidies.
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NPR Sponsor Announcer
So.
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Selena Simmons Duffin
So, you know, not everybody is going to be hit by really, really, really high premiums. It depends on your income and where you live and your age and all of these other factors. Some people's premiums are not going up, but on average, premiums are going to double for people. And for certain people, especially those who are older, right before the time where you can enroll in Medicare at 65, premiums are going to quadruple or, you know, really, really high thousands of dollars a month. And it's just not really doable for a lot of people that this Congressional Budget Office estimates that 4 million people will become uninsured because of these enhanced subsidies going away.
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Sarah McCammon
And geographically, where is this going to land?
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Selena Simmons Duffin
Yeah, so that's interesting, actually. Republican states and Republican voters seemed like they're going to be the hardest hit here. And part of the reason for that is these are states that decided not to expand Medicaid. Texas is a really big one. Florida, Georgia, places where people who might otherwise enroll in an expanded version of Medicaid are enrolled in these Obamacare health insurance plans instead. And they, if they're low income, like if they're kind of close to what a Medicaid expanded population would be, they're really benefiting the most from the enhanced subsidies. So the kff, which is the nonprofit health research organization, estimates that three out of every four people enrolled in these plans lives in a state won by President Trump in 2024. So, I mean, it makes sense that Republican lawmakers are feeling nervous because this is going to have a disproportionate impact on Republican states.
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Sarah McCammon
You know, President Trump has been promising to fix Obamacare essentially, really, since he first ran. Where does he come into all of this?
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Deirdre Walsh
We haven't heard the president really talk about repealing and replacing Obamacare since the first term where he failed, except to complain about the Late Senator John McCain, who foiled that effort. But in terms of this debate this year, ahead of the deadline, at the end of this month, the president has really just been on the sidelines. He hasn't been involved in the negotiations. There haven't really been many negotiations. Lawmakers from both parties say that President Trump is the one person that could change the political dynamic. If he decided to negotiate a deal, he could get one through, because there are a lot of Republicans who represent these swing districts and are facing critical races that can help determine the majority in the Senate and the house in the 2026 midterms that want a deal. And it would probably be some mix of a short term extension for a year or two with some limitations on eligibility for who could get these enhanced subsidies? Both Democrats and Republicans have talked about putting income caps on these subsidies. They say the majority of people who get them now make under $200,000. So why not cap it? Somewhere around there, there is bipartisan agreement that there is waste, fraud and abuse in the system and that there are things that they could do to crack down on that. And it's something that you could see getting bipartisan support. But President Trump hasn't been focused on domestic issues and has largely decided that his big legislative accomplishment is the tax bill that passed earlier this year. Whether or not Republicans who will be on the ballot in 2026 can convince him that he needs to get involved in order for them to keep control of the House and the Senate is another matter. If he decides it's in his political interests, he could change the dynamic. But there's no sign that he's ready to do that, and the clock is ticking. I do think that Congress will still be working on this issue next year, and that dynamic will also be when people are getting these bills. And that could force more people to put pressure on their leadership on the Hill and on the president.
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Selena Simmons Duffin
Yeah, and the timing here is really, really tough for people who enroll in these plans because open enrollment is happening right now. So people are having to kind of make their coverage decisions, imagining that Congress will not act and pay their premiums. You know, they Only have until December 15th to choose coverage that begins in the new year.
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Sarah McCammon
And let's remember, this was one of the major reasons for the shutdown. This is an issue that the Democrats are not likely to let go of, especially if these premiums start to hit constituents all over the country.
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Deirdre Walsh
Right. All right.
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Sarah McCammon
Well, let's leave it there for today. Thank you for being with us, Selena.
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Selena Simmons Duffin
Oh, thanks for having me.
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Sarah McCammon
I'm Sarah McCammon. I cover politics.
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Deirdre Walsh
And I'm Deirdre Walsh. I cover Congress.
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Sarah McCammon
And thank you for listening to the NPR Politics podcast.
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NPR Sponsor Announcer
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