The NPR Politics Podcast - Health Insurance Subsidies Expire This Month But Congress Can't Agree On A Fix

Episode Date: December 11, 2025

The enhanced subsidies 22 million Americans use to help pay for health insurance are set to expire at the end of this month, and when they do, many Americans will see their insurance premiums balloon. We discuss Democrats' and Republicans' competing proposals to address rising healthcare costs and whether Congress is likely to come to an agreement before — or after — the looming deadline. This episode: political correspondent Sarah McCammon, congressional correspondent Deirdre Walsh, and health policy correspondent Selena Simmons-Duffin.This podcast was produced by Casey Morell and Bria Suggs, and edited by Rachel Baye.Our executive producer is Muthoni Muturi.Listen to every episode of the NPR Politics Podcast sponsor-free, unlock access to bonus episodes with more from the NPR Politics team, and support public media when you sign up for The NPR Politics Podcast+ at plus.npr.org/politics.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

This message comes from Bayer. Science is a rigorous process that requires questions, testing, transparency, and results that can be proven. This approach is integral to every breakthrough Bayer brings forward. Innovations that save lives and feed the world. Science Delivers.com. Hey there, it's Tamara Keith. And real quick, before we start the show, I want to take a minute to talk about public media. It's what makes the NPR Politics Podcast and other NPR podcast special.

Public media was founded to inform, to educate, to expand our perspective. But as of this fall, federal funding for public media, including NPR and local NPR stations, has been eliminated. Despite that, we remain committed to this work to give you the context and analysis you need to make sense of the news coming out of Washington. This year alone, we've covered President Trump's second term from every angle, reshaping the federal government, launching a government. global trade war, an immigration crackdown in U.S. cities, and so much more. You can help us keep this work going in 2026. Thank you if you already go the extra mile as an NPR Plus supporter. If not, you can join the Plus community, get a bunch of perks like bonus episodes and more from NPR's podcasts, and you'll be supporting public media by signing up for NPR Plus today. Just go to plus.npr.org.

Hi, this is Kevin Francisco in Fort George Mead, Maryland. I am minutes away from starting my retirement ceremony after serving 20 years in the Air Force. This podcast was recorded at 12.36 p.m. Eastern Time on Thursday, December 11th, 2025. Things may have changed by the time you hear this, but I would have hopefully made the successful transition from Massa Sergeant Francisco to Mr. Francisco. Okay, here's the show. Congratulations and thank you for your service. Yes, thank you for your service. Onward and upward.

Hey there, it's the NPR Politics Podcast. I'm Sarah McCammon. I cover politics. And I'm Deirdre Walsh. I cover Congress. Today we also have NPR health policy correspondent Selena Simmons-Duffin with us. Hi, Selena. Hi. Thanks for having me. And today on the show, many Americans will soon face much higher health insurance premiums unless Congress steps in.

That's because enhanced subsidies that reduce those. premium costs for people who buy insurance through the Affordable Care Act marketplaces are expiring in just a couple of weeks. So, Deirdre, as of this taping, the Senate is voting on competing proposals to address this problem, one from Republicans and another from Democrats. Let's start with what Democrats want to do. They want to extend these existing enhanced Affordable Care Act subsidies for three more years. They're calling it a clean extension. There are some other tweaks in the bill, but it basically just keeps the current subsidies going for another three years. We do not expect that to advance. And what about the Republicans? So the Republican

bill actually just failed to advance in the Senate. What Republicans were proposing to do, and this was a proposal from the chairman of the HELP Committee that oversees Health Care in the Senate, Bill Cassidy from Louisiana, and the Finance Committee Chairman Mike Crapo. What they want to do, do is not extend the subsidies that are going to expire at the end of this month, but instead basically redirect money for consumers to go into health savings accounts. And it would be up to $1,500 for these HSAs. For the year? Correct. And that is a proposal that they argue would give the money directly to the patient instead of the insurance companies. They argue that the current existing enhanced health care subsidies are giving too much money to the insurance

companies and that this will help patients have more of a choice. That is a proposal that President Trump, in concept, has said that he likes, giving money directly to consumers. But Democrats oppose it, and it did not get the 60 votes it needed to advance. In the Republican bill, it would take about $10 billion to put into health savings accounts, and those accounts would only be for a certain, like a portion of the 24 million people who use these plans. Not everybody would be eligible for them. And in the Democrats plan, the enhanced subsidies cost about $35 billion a year. And so I talk to Mark Pauley. He's a health

economist at the Wharton School at the University of Pennsylvania. He mentioned that there's really a trade-off that economists are there to tell people about, which is that if you pay more, you get more, but it will also cost you more. Usually politicians try to change the subject by saying, well, I have a magic way that we can cut costs without having to make this trade-off, whether that be health savings account or whether it be Medicare for all, depending on which side of the eye you're looking at. But at least so far, there doesn't seem to be much evidence that there's a real pixie dust that can be scattered over this thing.

And what does that mean, Selena, you know, for patients, for consumers? Yeah, I mean, the way that the subsidies, these enhanced subsidies worked, is that you would only ever pay a certain portion of your income. So if you were low income and you wanted to select a very generous plan, then you would get a lot of money every single month, not directly, but towards your premium to make it really kind of affordable for you. this system, you couldn't use the $1,000 or the $1,500 towards your premium at all. And as you mentioned, it's per year, you know, like I talked to a woman this week who lives in West Virginia and she's looking at a $2,000 premium every month. So $1,500 a year is just like not even going to cut into that at all. It also sounds like some of these ideas sort of echo what was being discussed over the summer

when Congress was debating the so-called one big beautiful bill, the tax and spending bill. How does this current debate compare to what happened back then? Yeah, I was really struck by the fact that the Republican bill included some kind of wish list items that didn't survive because it was using the reconciliation process and it had to be related to the budget. So, for example, you know, this health savings account is the first part and we're going to give this much money and that's going to help people with their health costs. And then it says abortion can't be covered in these plans and gender affirming care can't be covered in these plans or Medicaid or chip the children's health insurance program for anyone of any age. These are health provisions that fell out over the summer, basically, that they're sticking back into this bill. But as Deirdre said, it did not advance. On the Democratic side, they're trying to undo some of the provisions that affected the Affordable Care Act in that bill.

So, for example, one of the ways that the one big beautiful bill raised money on the health side was getting rid of a cap in terms of repayment. So it's a little complicated, but basically a lot of people who buy these plans are self-employed or run their own companies. So they're making a guess on how much money they're going to make. They don't have a salary, right? And so the amount of subsidy is based on your income. And if your income is a guess, then that creates kind of the situation where you might have to repay some of the subsidy. And in the old system, there was a cap where you wouldn't have to pay tens of thousands of dollars if you really had a good year. You know, for example, over the summer, they got rid of the cap.

So I talked to a small business owner who was really concerned about this. She lives in Georgia and she was saying, like, this could really, like, crater my income if I guess wrong. I mean, I think in the case of both of these bills, point that Selena made, these are essentially like wish lists for both parties. No one was under any illusion in the Senate that either one of these proposals was going to advance. Up until this week, Republicans weren't even sure they were going to put up a plan of their own because they're so divided about what they want to do going forward. And there are multiple Senate Republican plans. Some include a short-term extension of these subsidies for one or two years. So I think the political argument a lot of Senate Republicans made was we can't just block an extension and not have a plan of our own to talk about.

So I think that's sort of what we're seeing here is this is both a messaging exercise from both parties. But as we've discussed, if nothing gets done, consumers are going to feel the impact of these cost increases pretty soon. And we're going to talk more about that in a moment. But first we're going to take a quick break. We'll be right back. This message comes from Wise, the app for using money around the globe. When you manage your money with Wise, you'll always get the mid-market exchange rate with no hidden fees. Join millions of customers and visit Wise.com.

T's and Cs apply. Support for this podcast comes from Dignity Memorial. For many families, remembering loved ones means honoring the details that made them unique. Dignity Memorial is dedicated to. to professionalism and compassion in every detail of a life celebration. Find a provider near you at DignityMemorial.com. You come to the New Yorker Radio Hour for conversations that go deeper with people you really want to hear from, whether it's Bruce Springsteen or Questlove or Olivia

Rodrigo, Liz Cheney, or the godfather of artificial intelligence, Jeffrey Hinton, or some of my extraordinarily well-informed colleagues, at The New Yorker. So join us every week on the New Yorker Radio Hour, wherever you listen to podcasts. This message comes from the NBC News original podcast, Here's the Scoop. Every evening, join NBC News reporters

for a deep dive into the day's top stories, from the front page to the zeitgeist in 15 minutes or less. Search, here's the scoop to follow now. And we're back. We've been talking about a fight on Capitol Hill over the Affordable Care Act health insurance subsidies, which expire in a couple of weeks. And we've been talking about the competing proposals in the Senate. Deirdre, what's happening in the

House? There's a lot of talking about ideas or concepts of a plan, but there is nothing headed towards the floor right now. And we are obviously staring down this big deadline at the end of the month. House Speaker Mike Johnson surprised a lot of people last week when he said, oh, the House is going to vote on a health care bill because they didn't have agreement within the Republican conference on a health care bill, just like we've seen in the Senate Republican conference. So what he's done is said, here are a bunch of ideas, including the approach that the Senate Republicans took with the health savings accounts and some other ideas about association health care plans, reforms for hospitals, reforms for prescription drug distribution,

these are all sort of a bunch of different health care ideas. And he said, we're going to talk about it and then we're going to move forward and vote on some of these things. But it's really unclear what the substance of the bill that the House will ultimately vote on or when that vote is going to happen. Congress is in session this week and next week, but then it takes a recess for the holidays and doesn't come back till January. Obviously, in that time period, these subsidies are going to expire. Congress doesn't do big things like health care bills in the span of a couple weeks, so it's very unlikely that we're going to see anything. The other thing that's happening in the House is that a bunch of House Republicans who represent competitive districts are very upset that the Speaker is not talking about any type of extension, one year, two year, three, or anything for the ACA subsidies. And they have instead rolled out their own proposals. One bipartisan group has a one-year extension with some reforms in year two. Another bill has a two-year extension with some other reforms and expanded health care savings accounts. And what these

swing district Republicans have done is they've used a process that is pretty rarely used, but in this Congress, it has been used effectively, and that is filing what's called a discharge petition to force a vote on the House floor. If you get 218 signatures, which is a majority of the members of the House, to sign this petition, it forces the issue and it forces a vote on the House floor. There is a bunch of procedural stuff that has to happen in terms of timing. So there isn't enough time to force that vote ahead of the expiration of these subsidies. But there are enough Republicans if Democrats decided to join them to force a vote on the House floor. And we don't know whether Democrats are going to do that because the position of the House Democrats right now is they are insisting on a three-year extension of these existing ACA subsidies.

Republicans would potentially support this move, right, Deirdre, because they're so concerned, at least some of these lawmakers are about how this is going to hit their constituents. They are publicly warning that so many constituents in their districts aren't going to be able to afford health care and will lose their. coverage and that politically this is a bad issue for the Republican Party when the central issue that is animating voters right now is affordability. And a lot of these Republicans I've talked to is say at the top of the list is how unaffordable health care is. And if we make it even more unaffordable by forcing, you know, millions of Americans, many of which reside in red states and red districts to pay these skyrocketing premium starting in January, there will be a political backlash. Selina, there appears to be no direct path to getting something done here. If Congress

does nothing and these premiums hit in a couple of weeks, what is the impact? I mean, how many people are we talking about that are facing these higher premiums? Yeah, I mean, it's going to affect a lot of people. 24 million people, as I mentioned, are enrolled in these plans, and 22 million of them were benefiting from the enhanced premium subsidies. So, you know, not everybody is going to be hit by really, really, really high premiums. It depends on your income and where you live and your age and all of these other factors. Some people's premiums are not going up, but on average, premiums are going to double for people. And for certain people, especially those who are older right before the time where you can enroll in Medicare at 65, premiums are going to

quadruple or, you know, really, really high thousands of dollars a month. And it's just not really doable for a lot of people that this Congressional Budget Office estimates that four million people will become uninsured because of these enhanced subsidies going away. And geographically, where is this going to land? Yeah, so that's interesting. Actually, Republican states and Republican voters seemed like they're going to be the hardest hit here. And part of the reason for that is these are states that decided not to expand Medicaid. Texas is a really big one. Florida, Georgia, places where people who might otherwise enroll in an expanded version of Medicaid

are enrolled in these Obamacare health insurance plans instead. And they, if they're low income, like if they're kind of close to what a Medicaid expanded population would be, they're really benefiting the most from the enhanced subsidies. So the KFF, which is the nonprofit health research organization, estimates that three out of every four people enrolled in these plans lives in a state won by President Trump in 2024. So, I mean, it makes sense that Republican lawmakers are feeling nervous because this is going to have a disproportionate impact on Republican states. You know, President Trump has been promising to fix. Obamacare, essentially, really since he first ran. Where does he come into all of this?

We haven't heard the president really talk about repealing and replacing Obamacare since the first term where he failed, except to complain about the late Senator John McCain, who foiled that effort. But in terms of this debate this year ahead of the deadline at the end of this month, the president has really just been on the sidelines. He hasn't been involved in the negotiations. There haven't really been many negotiations. lawmakers from both parties say that President Trump is the one person that could change the political dynamic. If he decided to negotiate a deal, he could get one through because there are a lot of Republicans who represent these swing districts and are facing critical races that can help determine

the majority in the Senate and the House in the 26 midterms that want a deal. And it would probably be some mix of a short-term extension for a year or two with some limitations on eligibility for who could get these enhanced subsidies. Both Democrats and Republicans have talked about putting income caps on these subsidies. They say the majority of people who get them now make under $200,000, so why not cap it somewhere around there? There is bipartisan agreement that there is waste, fraud, and abuse in the system, and that there are things that they can. could do to crack down on that. And it's something that you could see getting bipartisan support. But President Trump hasn't been focused on domestic issues and has largely decided that his big

legislative accomplishment is the tax bill that passed earlier this year. Whether or not Republicans who will be on the ballot in 2026 can convince him that he needs to get involved in order for them to keep control of the House and the Senate is another matter. If he decides it's in his political interests, he could change the dynamic. But there's no sign that he's ready to do that and the clock is ticking. I do think that Congress will still be working on this issue next year. And that dynamic will also be when people are getting these bills. And that could force more people to put pressure on their leadership on the Hill and on the president. Yeah, and the timing here is really, really tough for people who enroll in these plans because

open enrollment is happening right now. So people are having to kind of make their coverage decisions imagining that Congress will not act and pay their premiums. You know, they only have until December 15th to choose coverage that begins in the new year. And let's remember this was one of the major reasons for the shutdown. This is an issue that the Democrats are not likely to let go of, especially if these premiums start to hit constituents all over the country. Right. All right, well, let's leave it there for today. Thank you for being with us, Selena. Oh, thanks for having me. I'm Sarah McCammon. I cover politics. And I'm Deirdre Walsh. I cover Congress. And thank you for listening to the NPR Politics Podcast.

There's a lot going on right now, mounting economic inequality, threats to democracy, environmental disaster, the sour stench of chaos in the air. I'm Brooke Gladstone, host of WNYC's On the Media. Want to understand the reasons and the meanings of the narratives that led us here and maybe how to head them off at the past? That's on the media's specialty. Take a listen wherever you get your podcasts. Thank you.