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Louisiana Republican U.S. Sen. Bill Cassidy talks with reporters in the Dirksen Senate office building on Wednesday, Dec. 3, 2025. (Photo by Jennifer Shutt\/States Newsroom)<\/p>\n
WASHINGTON \u2014 The U.S. Senate committee that oversees health care started coalescing around an approach to lower costs for Americans during a Wednesday hearing, though several hurdles lay ahead.<\/p>\n
Republicans and Democrats on the panel appeared to accept that enhanced tax credits for people who purchase their health insurance from the Affordable Care Act marketplace should not expire at the end of the year. Just days are left for open enrollment and premiums are expected to greatly increase.\u00a0<\/p>\n
The bipartisan momentum among a select group of senators will need to build significantly in the days ahead if an extension of the subsidies is going to speedily garner the 60 votes needed to advance in the Senate and then move through the GOP-controlled House.\u00a0<\/p>\n
It will also need President Donald Trump\u2019s signature to become law, and he has so far not signaled support for an extension.<\/p>\n
\u201cI\u2019m hoping that we can find a bill that can get 60 votes, that can fix the problem with the exchanges for January 1, 2026,\u201d Health, Education, Labor and Pensions Committee Chairman Bill Cassidy, R-La., said. \u201cIt shouldn\u2019t be a Republican solution. It shouldn\u2019t be a Democratic solution. It should be an American solution.\u201d<\/p>\n
Cassidy cautioned lawmakers on the panel from pressing for \u201cgrandiose ideas,\u201d saying Congress must \u201chave a solution for three weeks from now.\u201d\u00a0\u00a0<\/p>\n
But extending the ACA marketplace subsidies, possibly with tweaks, is just a short-term solution that senators on the committee agreed will need to be followed up with an overhaul of the American health care system.\u00a0<\/p>\n
Any efforts on larger-scale legislation will bump up against the deeply entrenched politics of the Affordable Care Act, well-funded lobbyists and next year\u2019s midterm elections, none of which will make the process easy.\u00a0<\/p>\n
Vermont independent Sen. Bernie Sanders, the ranking member on the panel, said he appreciated Cassidy\u2019s \u201csentiment about wanting to do something quickly,\u201d but said Republicans should have focused on the expiring ACA tax credits earlier in the year, instead of leaving it until now.\u00a0\u00a0<\/p>\n
\u201cThe reason for this hearing, to be frank, is that my Republican friends understand they\u2019ve got a political problem,\u201d Sanders said. \u201cTheir political problem is that all over America today, people on the Affordable Care Act are opening up packages coming from the insurance companies, and guess what? Their premiums on average are doubling and in some cases in my state are tripling or quadrupling.\u201d<\/p>\n
Sanders said Congress should extend the enhanced ACA marketplace tax credits for another year, or two, or three, while lawmakers sort through larger, structural issues around health care costs.\u00a0<\/p>\n
\u201cYes, the current system is broken. Yes, we need to create a new system,\u201d Sanders said. \u201cBut unfortunately, we aren\u2019t going to do it in two weeks.\u201d<\/p>\n
Sanders suggested the committee hold a series of hearings in the months ahead featuring leaders from other developed countries that provide health care to all of their residents.<\/p>\n
Maine Republican Sen. Susan Collins said \u201cthere\u2019s a limit to what we can do in this first year\u201d and that lawmakers are \u201cgoing to need a two-year plan.\u201d<\/p>\n
Collins indicated that she wants to see \u201creasonable\u201d income caps to limit eligibility for ACA marketplace tax credits in any short-term extension that Congress may pass.\u00a0<\/p>\n
Washington state Democratic Sen. Patty Murray said Republicans who are serious about addressing the spike in costs for ACA marketplace enrollees should work with Democrats to pass a \u201cclean, one-year extension\u201d of the enhanced subsidies.\u00a0<\/p>\n
\u201cAnd if their call for reforming tax credits is serious, we should look at that. We can talk about those reforms ahead of the 2027 year,\u201d Murray said. \u201cBut I have to say, I\u2019m not optimistic that most Republicans are serious about this because they refused to talk about this problem before right now, and I\u2019ve been down this road before.\u201d<\/p>\n
Murray also rebuked Cassidy for not focusing the committee\u2019s attention on the expiring tax credits earlier in the year by taking a swipe at his vote to confirm Health and Human Services Secretary Robert F. Kennedy Jr.<\/p>\n
\u201cThis is about as serious as expressing concern about RFK Jr.\u2019s anti-vax crusade after voting to make him the most powerful public health official in the country,\u201d Murray said.<\/p>\n
Alaska Republican Sen. Lisa Murkowski said members of the committee need to focus on what the next few months and years look like for Americans\u2019 health care costs.\u00a0<\/p>\n
\u201cI think we\u2019re going to need to have a short-term extension. But I think we can put reasonable caps on. I think that we can put some of the parameters that we have been talking about. There\u2019s no great secret sauce here to how we\u2019re going to deal with this particular dilemma that we\u2019re in,\u201d Murkowski said. \u201cBut we\u2019ve got to be looking longer term to \u2014 how do we ultimately reduce these costs of care?\u201d<\/p>\n
Murkowski said she was also concerned about a decrease in funding for public health and prevention initiatives, before asking the witnesses appearing before the committee what their top recommendations would be for \u201cprevention-type programs that have the strongest evidence for reducing long-term costs.\u201d<\/p>\n
Joel White, president of the Council for Affordable Health Coverage in Washington, D.C., said Congress should allow \u201cpremium discounts in the individual market for wellness programs,\u201d which he said is currently illegal.<\/p>\n
Marcie Strouse, owner and partner at Capitol Benefits Group in Des Moines, Iowa, suggested lawmakers open up health savings accounts \u201cto allow for more holistic and preventive services.\u201d She also said Congress could highlight \u201cdirect primary care and making sure people are actually getting the care that they need.\u201d<\/p>\n
Dr. Claudia M. Fegan, national coordinator at Physicians for a National Health Program in Chicago, suggested enhanced primary care and screening people for diseases like cancer that can be easier to treat when caught early.\u00a0<\/p>\n
Wisconsin Democratic Sen. Tammy Baldwin said the hearing clearly demonstrated that there is \u201cunderlying agreement that this system needs a lot of reform.\u201d<\/p>\n
But, she said, Congress needs to take a look at the entire health care system, not just the Affordable Care Act.\u00a0<\/p>\n
\u201cI want to make a point that just under 50% of Americans get their health insurance through employers or group insurance, 20% are on Medicaid, 15% on Medicare, 1% on TRICARE or VA, and just over 6% are in this market,\u201d Baldwin said. \u201cThere are problems with this market. But I have to say that abandoning the ACA \u2026 is not going to solve the system as a whole.\u201d<\/p>\n
Ohio Republican Sen. Jon Husted appeared supportive of a short-term extension of the enhanced ACA tax credits to provide Congress more time to address larger issues with health care affordability.<\/p>\n
\u201cWe can freeze the subsidies where they\u2019re at right now for a temporary period of time. I don\u2019t know if that\u2019s one year or two years to help give some relief,\u201d he said. \u201cAnd by the way, just because we continue those tax credits does not drive down the cost. It transfers the burden to the taxpayer and future generations. But it is a little help right now that we both can agree on. And then we\u2019ve got to fix it.\u201d\u00a0<\/p>\n
Husted said there are easily a dozen bills that Congress could take up individually to start bringing down health care costs.\u00a0<\/p>\n
Missouri Republican Sen. Josh Hawley also appeared to side with extending the enhanced ACA marketplace tax credits in the short term.<\/p>\n
\u201cWe are looking at a massive crisis unless Congress acts and acts soon,\u201d Hawley said. \u201cAnd my message is to the leadership of this body \u2014 to the leaders of the House, the leaders of the Senate \u2014maybe it\u2019s time we all locked ourselves in a room and got to a solution here.\u201d<\/p>\n
Halwey pitched a bill he just introduced to exempt health care from taxes.\u00a0<\/p>\n
\u201cIf you pay premiums, you ought to be able to deduct that from your taxes. If you have out-of-pocket medical expenses, you ought to be able to deduct every dollar off of your taxes. You want to lower the cost of health care immediately. Do that. No taxes on health care for any American,\u201d Hawley said. \u201cAnd you set an upper limit so you don\u2019t have rich people gaming the system. I get it. That\u2019s fine. But let\u2019s think about working people in this country who cannot afford health care.\u201d<\/p>\n
Hawley said it should be allowed whether an American itemizes on their taxes or not.\u00a0<\/p>\n
All three panelists seemed initially supportive of the idea.\u00a0<\/p>\n