The Senate has advanced a package to end the shutdown – with House consideration expected today. The package, however, holds off on addressing the soon-to-expire Affordable Care Act premium tax credit enhancements until after the government reopens. Meanwhile, lawmakers continue to offer proposals on how to modify premium tax credits while maintaining healthcare access.
On November 9, Senate Majority Leader Thune forwarded what he described as a “clean continuing resolution (CR), packaged with three bipartisan, yearlong appropriations bills.” The Senate approved the CR 60-40 Monday night, with the House scheduled to take up the package Wednesday.
The CR provides funding for other portions of the federal government through January. Thune said the yearlong bills included in the package “will fund SNAP for the entire fiscal year, they will fund WIC for the entire fiscal year, and they will fund our veterans for the entire fiscal year.”
Also part of the deal, said Senator Tim Kaine (D-VA) – one of a handful of Democrats to vote to advance the CR – are supports for federal workers. That includes provisions to “protect federal workers from baseless firings, reinstate those who have been wrongfully terminated during the shutdown, and ensure federal workers receive back pay,” Kaine explained.
No Deal on Premium Tax Credits Yet
Notably absent from the CR was an agreement on the future of the ACA enhanced premium tax credits. However, Thune has committed to scheduling a vote on a proposal to address the expiring enhancements by mid-December.
Thune acknowledged the country’s “healthcare crisis” on the Senate floor, stating “I am thankful to be able to say that we have Senators, both Democrat and Republican, who are eager to get to work to address that crisis in a bipartisan way.” The majority leader added that President Trump “is willing to sit down and get to work on this issue.”
Thune promised Democrats he would “schedule a vote on their proposal.” He said he’s “committed to having that vote no later than the second week in December.”
Senator Dick Durbin (D-IL), who also voted to advance the package, said Thune had “assured” him he would “keep his word” about bringing a Democratic ACA premium tax credit bill to the floor in December. “It is my fervent hope that this ends up being a bipartisan effort,” Durbin added, during November 10 floor remarks.
Senate Minority Leader Chuck Schumer (D-NY), who voted against bringing the CR up for consideration, countered that Republicans have already had “three chances this year to extend the ACA premium tax credits.” He noted Republicans most recently rejected a proposal, brought last Friday, to extend the enhanced credits for just one year. “[W]hen they said no on our compromise, they showed that they are against any healthcare reform,” said Schumer, referring to the one-year extension proposal.
Premium Tax Credit Proposals Abound
Despite Republicans’ refusal to address premium tax credits as part of a government funding package, members have forwarded several options for preserving some form of the enhanced credit – at least temporarily.
Back in September, Representatives Jennifer Kiggans (R-VA) led the introduction of the Bipartisan Premium Tax Credit Extension Act (H.R. 5145). That bill would extend the enhanced premium tax credit for one year. It has amassed 28 co-sponsors, half of whom are Republicans. “While the enhanced premium tax credit created during the pandemic was meant to be temporary, we should not let it expire without a plan in place,” Kiggans explained.
Kiggans, along with Representative Jefferson Van Drew (R-NJ) headed up an October 21 letter urging that once the government reopens, Congress “immediately turn our focus to the growing crisis of healthcare affordability and the looming expiration of the enhanced Affordable Care Act (ACA) premium tax credits.” The letter, sent to House Speaker Mike Johnson (R-LA), was signed by 11 other House Republicans.
Last week, four House members shared their bipartisan “principles” for enhanced premium tax credit extensions and modifications. Among those principles were adding new income limits and guardrails to prevent fraud.
Then, on Monday, a bipartisan House duo offered a more detailed take on the premium tax credit in 2026 and beyond. Representatives Sam Liccardo (D-CA) and Kevin Kiley’s (R-CA) Fix It Act would provide for a two-year extension, while capping credit recipients’ income at six times the poverty level. The bill would also crack down on fraud by incorporating the Insurance Fraud Accountability Act (S. 976/H.R. 2079). That Democrat-led proposal takes aim at health insurance brokers who enroll individuals in ACA plans without their knowledge, to collect commissions.
Beyond these two reforms, Liccardo and Kiley would make up the cost of the two-year extension by tackling Medicare Advantage risk scoring. Because Medicare Advantage reimbursements are based on patient health, insurers may associate “inflated risk scores” with “relatively healthy patients,” they explain in a fact sheet. Liccardo and Kiley’s bill incorporates the text of the bipartisan No UPCODE Act (S. 1105).
New income limits were also part of a Democrat-backed bill, the Keep Healthcare Affordable Act. Sponsor Representative Brad Schneider (D-IL) calls for a four-year extension of the enhanced credits – but would limit credit availability to those under 1,000% of the federal poverty level.
But Senator Bill Cassidy (R-LA) has offered a different approach centered on Flexible Spending Accounts. Under his proposal, “every eligible American citizen on the Exchange would receive a pre-funded Flexible Spending Account equal in value to the enhanced premium tax credit they would have received had the money going through their insurance company.” Cassidy explained that this would provide more flexibility for individuals and families “to pay for prescription drugs, for dental work, for medical care, eyeglasses, orthodontia.”
Cassidy, speaking on the House floor Monday, argued that Exchange FSAs “can happen for plan year 2026.” He views his proposal as an extension of “current law” applicable for non-Exchange plans – and suggests existing “tools” and “vendors” can be used to implement Exchange FSAs on a short timeline.
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