paywall

paywall

Photo: Graeme Sloan/Bloomberg/Getty Images

Given the fraught nature of so much that has happened in politics during 2025, America has earned a holiday respite aside from the sordid blood-letting our self-styled “secretary of War” has either encouraged or ordered in the Caribbean. But there is a slow-motion crisis that continues to fester in Washington involving health-care policy, a Republican Achilles’ heel that never seems to heal. As part of the deal that led a crucial number of Democrats to support an end to the recent government shutdown, the Senate will hold some sort of vote next week on some sort of plan to address the rapidly approaching year-end expiration of increased Obamacare premium subsidies enacted in 2021. Both premiums and out-of-pocket health-care costs will skyrocket for up to 24 million Americans if nothing happens by December 31. The biggest impact will be in those red states that refused to expand Medicaid (as allowed by the Affordable Care Act) and thus made a lot more people rely on Obamacare policies. And a failure to act by this Republican-controlled Congress would cast a harsh light on its earlier health-care policy travesties (notably the Medicaid cuts featured in the One Big Beautiful Bill Act) that Democrats will surely exploit in the 2026 midterms.

There is a small segment of politically vulnerable congressional Republicans who would just as soon extend the subsidies for a year or two and move on. But the bulk of the GOP, particularly in the fever swamps of the U.S. House, despise anything remotely connected to Obamacare like sin itself. So throughout the debate over the subsidies, it’s been assumed by everyone that any deal on the subsidies would have to be brokered by Donald Trump and then imposed on the House Freedom Caucus types whose fear of and love for the 47th president exceed even their hatred for Obamacare.

So what will Trump and both parties in Congress ultimately do about health care in the coming weeks? Here are the likeliest outcomes.

Cut a deal to extend Obamacare subsidies, with goodies for Republicans

This was the solution that seemed close to fruition less than two weeks ago: a Trump-brokered deal that would reportedly have extended the Obamacare subsidies for two years, with Republicans obtaining (1) modestly restricted eligibility and a minimum premium requirement to deal with alleged “fraud”; and (2) some sort of down payment on the kind of direct payments to individuals conservatives tend to favor as an alternative to regulated private health-insurance markets like the one created by the ACA. The idea was that Trump and his allies could claim they had bought some time to fully develop the amazing Obamacare alternative Trump has been claiming to have in the back of his mind for the last decade, before scrapping the 44th president’s signature health-care initiative after the midterms are safely past. Meanwhile Democrats could declare victory on the subsidies issue and retroactively justify their position on the government shutdown.

According to multiple reports, House Republicans (and some of their noisier allies in the Senate) pitched an absolute fit over this plan, and Trump took it off the table. Because this happened at the same time as the congressional Republican “revolt” over the Epstein files, there was lots of over-interpretation of the health-care walk-back as a sign of Trump’s weakness, which couldn’t have pleased him. So it’s possible (if not likely) he’ll come back with something similar and the Obamacare subsidy crisis will be averted.

Reject competing health-care plans, resume partisan warfare

If Trump remains above the fray or resumes his on-again, off-again attacks on Obamacare as the source of all health-care evils, the promised Senate vote will likely be a ritualistic festival of partisanship, as Punchbowl News reports:

The Senate is barreling toward a health care vote next week that will amount to little more than a partisan messaging exercise — and a year-end subsidy cliff that will prompt massive premium hikes for millions of Americans.

Absent a major shift**,** senators are set to vote on a Democratic proposal to extend the enhanced Obamacare subsidies for a number of years, and potentially a “side-by-side” but yet-undefined GOP alternative. Neither of these proposals will get 60 votes.

To be clear, Democrats will return to the same “clean” Obamacare subsidy extension they demanded prior to the government shutdown, without any of the “reforms” they would very likely accept in an actual deal. Senate Republicans are scrambling to throw together some sort of health-care affordability initiative based on direct payments to individuals. And House Republicans are wasting a lot of time pretending to develop a comprehensive right-wing health-care initiative they know they can’t enact short of pursuing another budget-reconciliation package along the lines of the OBBBA, as Politico reports:

House Republicans are on a separate track altogether, with party leaders looking to assemble a suite of health care bills from three committees — Ways and Means, Energy and Commerce, and Education and Workforce. Their plan is less about making law, which would require buy-in from Senate Democrats, and more about showing voters that Republicans have plans to address rising health care costs….

“We’re nowhere on health care,” said one senior House Republican who was granted anonymity to candidly describe the situation.

That describes Congress as a whole if Trump doesn’t broker a deal.

Punt until the end of January

There are really two big deadlines for action or inaction on health care to keep in mind. The first and most obvious is the December 31 date on which the enhanced Obamacare premium subsidies expire and all hell breaks loose in private insurance markets. The second is on January 30, 2026, when the current stopgap spending measure that ended the recent government shutdown runs out. In theory, Congress was supposed to have worked out bipartisan appropriations bills to take care of the federal government’s fiscal needs for 2026 by then, but of course that hasn’t happened. So there will be another potential shutdown “cliff” and lots more finger-pointing and turmoil.

Democrats will have to decide whether to reprise their demands from the end of October and again refuse to vote for additional government funding unless something happens on the health-care front. And both parties will have to decide whether another shutdown is worth the toil and trouble this close to the midterms.

The president will remain the key player in the next chapter of the saga, so the real question may be whether he prefers to go to the electorate next November amid all-time-high levels of polarization and public dissatisfaction with Washington or get his party’s dysfunctional record on health care off the front burner with some sort of deal.

Will Trump Break the Health-care Deadlock or Make It Worse?

Will Trump Break the Health-care Deadlock or Make It Worse?