The Senate voted down two competing healthcare bills on Thursday, putting more generous financial assistance for Affordable Care Act plans on track to lapse in just a few weeks.
Both bills needed 60 votes to advance. Republican legislation spearheaded by Sens. Mike Crapo, R-Idaho, and Bill Cassidy, R-La., failed after a 51-48 vote. The bill would have replaced the enhanced subsidies with funds directly sent to health savings accounts tied to bronze and catastrophic plans.
Senators also rejected Democrats’ plan to extend the increased financial assistance at its current level for three years on a 51-48 vote.
Lawmakers largely voted along party lines for both measures, though Sen. Rand Paul, R-Ky., declined to support the Republicans’ HSA plan.
Sens. Susan Collins, R-Maine, Josh Hawley, R-Mo., Lisa Murkowski, R-Alaska, and Dan Sullivan, R-Alaska, voted to preserve the subsidies alongside Democrats.
The failure of both bills means the enhanced subsidies are almost certain to expire at the end of the year. Premiums are set to more than double and millions of enrollees are expected to drop their coverage as a result.
The loss of the subsidies would pressure providers’ finances too, as growing numbers of uninsured Americans would increase uncompensated care.
The enhanced financial assistance for ACA plans, first enacted during the COVID-19 pandemic, allowed many low-income beneficiaries to pay nothing for coverage while improving affordability for middle-income enrollees.
The subsidies, which were at the center of a historically long government shutdown this fall, have become a significant issue for lawmakers. Many Republicans argue the subsidies are too expensive and increase opportunities for fraud, but Democrats have pushed to extend the subsidies to avert a spike in healthcare costs.
Healthcare lobbies decried the failed vote to extend the subsidies. Margaret Murray, CEO of the Association for Community Affiliated Plans, said in a statement Thursday that the enhanced tax credits have been a “wildly successful way” to make coverage affordable, and letting them expire would “willfully shoot costs skyward.”
The Federation of American Hospitals urged lawmakers to quickly find a bipartisan solution and extend the subsidies.
“As we approach the holidays, millions of Americans living paycheck to paycheck face a disastrous choice: take on debt to afford skyrocketing premiums or risk going without coverage entirely,” Charlene MacDonald, executive vice president for public affairs at the FAH, said in a statement. “Congress cannot leave their constituents in this bind.”
