Louisiana Republican U.S. Sen. Bill Cassidy speaks with reporters in the Dirksen Senate office building, Wednesday, Dec. 3, 2025. (Photo by Jennifer Shutt/States Newsroom)
WASHINGTON – During a Wednesday hearing, the U.S. Senate committee that oversees health care began working on an approach to lower costs for Americans, although several hurdles lay ahead.
Republicans and Democrats on the panel seemed to accept that improved tax credits for people purchasing health insurance through the Affordable Care Act platform should not expire at the end of the year. There are only a few days left until open enrollment begins and premiums are expected to escalate significantly.
Bipartisan momentum among a select group of senators will need to build significantly in the coming days if the grant extension is to quickly provide the 60 votes needed to advance in the Senate and then pass the GOP-controlled House.
For it to come into force, it will also require the signature of President Donald Trump, who has not yet signaled support for the extension.
“I hope we can find a bill that will get 60 votes and that will solve the stock market problem on January 1, 2026.” said Health, Education, Labor and Pensions Committee Chairman Bill Cassidy, R-La. “It shouldn’t be a Republican solution. It shouldn’t be a Democratic solution. It should be an American solution.”
Cassidy cautioned panel lawmakers against pushing for “grand ideas,” saying Congress must “have a solution in three weeks.”
A “political problem” as seen for the GOP
But expanding the ACA’s market-based subsidies, perhaps with amendments, is only a short-term solution that committee senators say will be necessary, followed by an overhaul of the U.S. health care system.
Any broader legislative effort will run up against the entrenched politics of the Affordable Care Act, well-funded lobbyists, and next year’s midterm elections, none of which will make the process any easier.
Independent Vermont Sen. Bernie Sanders, a ranking member of the panel, said he appreciated Cassidy’s “sense of wanting to do something quickly,” but said Republicans should have focused on the expiring ACA tax breaks earlier this year rather than leaving it until now.
“Frankly, the reason for this hearing is because my Republican friends understand they have a political problem,” Sanders said. “Their political problem is that today, all over America, people covered by the Affordable Care Act are opening up plans from insurance companies and guess what? Their premiums are doubling on average, and in some cases in my state, tripling or quadrupling.”
Sanders said Congress should extend the ACA’s enhanced marketplace tax credits for another year, two or three, until lawmakers address larger structural problems with health care costs.
“Yes, the current system is broken. Yes, we need to create a new system,” Sanders said. “But unfortunately we won’t do it in two weeks.”
Sanders suggested that the committee hold a series of hearings in the coming months with leaders from other developed countries that provide health care to all of their people.
The extension of tax breaks was discussed
Maine Republican Sen. Susan Collins said that “there are limits to what we can do in the first year” and that lawmakers “will need a two-year plan.”
Collins has indicated that she wants “reasonable” income caps to limit eligibility for ACA marketplace tax credits in any short-term extension approved by Congress.
Washington state Democratic Sen. Patty Murray said Republicans who are grave about addressing rising costs for ACA marketplace enrollees should work with Democrats to pass a “clean one-year extension” of the increased subsidies.
“And if their call to reform tax breaks is serious, we should look at it. We can talk about those reforms before 2027,” Murray said. “But I have to say that I’m not optimistic that most Republicans are taking this seriously because they haven’t wanted to talk about this issue at this point, and I’ve been down this road before.”
Murray also chastised Cassidy for not focusing the committee’s attention on expiring tax credits earlier in the year, hand-waving his vote to confirm Secretary of Health and Human Services Robert F. Kennedy Jr.
“This is as serious as expressing concern about RFK Jr.’s anti-vaccine crusade after voting to make him the most powerful public health official in the country,” Murray said.
Support for “reasonable limits.”
Alaska Republican Sen. Lisa Murkowski said committee members need to focus on what Americans’ health care costs will look like over the next few months and years.
“I think we’re going to need a short-term extension. But I think we can impose reasonable restrictions. I think we can define some of the parameters that we’ve been talking about. There’s no big secret here about how we’re going to deal with this particular dilemma that we’re facing,” Murkowski said. “But we have to look at the long term – how do we ultimately reduce the cost of care?”
Murkowski also expressed concern about reduced funding for public health and prevention initiatives, and asked witnesses before the committee what their top recommendations would be for “preventive programs that have the strongest evidence of reducing costs over the long term.”
Joel White, president of the Council on Affordable Health Care in Washington, said Congress should allow “premium discounts in the individual wellness program market,” which he believes is currently illegal.
Marcie Strouse, owner and partner at Capitol Benefits Group in Des Moines, Iowa, suggested that lawmakers open health care savings accounts “to enable more holistic and preventive services.” She also said Congress could put an emphasis on “direct primary care and making sure people actually get the care they need.”
Dr. Claudia M. Fegan, national coordinator at Physicians for the National Health Program in Chicago, suggested improving primary care and screening for diseases such as cancer, which may be easier to treat if detected early.
Wisconsin Democratic Sen. Tammy Baldwin said the hearing clearly showed there was “basic agreement that this system needs a lot of reform.”
But she said Congress needs to look at the entire health care system, not just the Affordable Care Act.
“I want to note that a little less than 50% of Americans get health insurance through an employer or group insurance plan, 20% get through Medicaid, 15% get through Medicare, 1% get through TRICARE or the VA, and just over 6% are in that marketplace,” Baldwin said. “There are problems in this market. But I have to say that abandoning the ACA… will not solve the system as a whole.”
Ohio Republican Sen. Jon Husted appeared to support a short-term extension of the ACA’s enhanced tax credits to give Congress more time to address more pressing health care affordability issues.
“We might temporarily freeze the subsidies where they are now. I don’t know if it’s one year or two years to provide some relief,” he said. “And by the way, just because we continue these tax breaks doesn’t lower costs. It shifts the burden to the taxpayer and future generations. But right now, it’s a little bit of help that we can both agree on. And then we have to fix it.”
Husted said there are about a dozen bills Congress could pass individually to start lowering health care costs.
Hawley offers a tax-free plan for health care costs
Missouri Republican Sen. Josh Hawley also appears to be in favor of expanding the ACA’s enhanced marketplace tax credits in the miniature term.
“We are looking at a massive crisis if Congress doesn’t act and act quickly,” Hawley said. “My message is to the leadership of this body – to the leadership of the House and the leadership of the Senate – maybe it’s time for all of us to lock ourselves in a room and find a solution here.”
Halwey has just introduced a bill that would exempt health care from taxes.
“If you pay premiums, you should be able to deduct it from your taxes. If you have out-of-pocket medical expenses, you should be able to deduct every dollar from your taxes. You want to reduce health care costs immediately. Do it. No health care taxes for any American,” Hawley said. “And you put a cap on it so rich people don’t game the system. I get it. Fine. But let’s think about the working people in this country who can’t afford health care.”
Hawley said it should be allowed regardless of whether an American itemizes their taxes or not.
Initially, all three panelists seemed to support the idea.
Renewal of tax breaks in 2026
Cassidy said later two-hour interrogation is working to gain support from lawmakers of both political parties for an integrated approach for next year.
“You can take the income that would have been used to expand the subsidies, apply it to a bronze plan because the bronze plan is much cheaper. You can then roll that balance into a health care savings account,” Cassidy said, referring to coverage levels for plans in the ACA marketplace. “As such, it continues support using the existing mechanisms we have in place, but integrates an HSA that provides first-dollar coverage and could potentially lower the net deductible.”
Cassidy said Congress could extend the open enrollment period in the ACA marketplace and then fund health insurance savings accounts, which are tax-advantaged savings accounts, before the end of March.
“People kept their bills and sent them in for payment,” he said. “People do this all the time.”
