Health care subsidies for millions of Americans are likely to expire after the Senate failed to pass competing bills, a politically dangerous issue ahead of next year's midterm elections.
Both the Democratic and Republican plans fell short of the 60 votes needed to advance, meaning insurance premiums under the Affordable Care Act (ACA), also known as Obamacare, would more than double by the end of the year.
Opinion polls show a large majority of Americans favor extending the subsidies, with the cost of living a major issue among voters.
The issue has split Republicans as health care could become a hot topic in next year's congressional elections.
More than 24 million people have health insurance through Obamacare.
The subsidies, which expire Jan. 1, are additional tax breaks Democrats passed in 2021 during the Covid pandemic.
On Thursday, senators rejected both a Democratic bill to extend the subsidies for three years and a Republican proposal to create a new Health Savings Account for Americans whose income is less than 700% of the federal poverty level.
The Republican-backed plan failed 51 to 48, and the Democratic plan lost by the same margin.
Four Republicans, Susan Collins of Maine, Josh Hawley of Missouri, and Dan Sullivan and Lisa Murkowski, both of Alaska, voted for the Democratic bill.
Speaking ahead of the vote, Senate Minority Leader Chuck Schumer, a New York Democrat, warned Republicans that this was their last chance to act before the subsidies expire.
“Let's prevent disaster,” he said. “The American people are watching.”
The standoff in Congress over expiring subsidies triggered the longest government shutdown in history this fall, lasting 43 days.
Republicans have long argued that Obamacare is riddled with fraudulent claims and that it fails to deliver the affordable health care promised in the bill's title.
They say health savings accounts will benefit consumers directly, not insurance companies.
While Trump has not publicly endorsed the Republican plan, he told Politico earlier this week that he wants to “give money to the people, not the insurance companies.”
Before senators voted Thursday, Senate Majority Leader John Thune, a South Dakota Republican, again opposed extending those subsidies.
He characterized them as “an attempt to hide the real impact of rising health care costs under Obamacare.”
While some Republicans on Capitol Hill have called for a compromise or extension of the subsidies until an agreement is reached with Democrats, there have yet to be high-level talks on the topic.
Speaking at the White House on Thursday, press secretary Caroline Leavitt laid the blame on Democrats and said Covid-era health insurance subsidies have “completely distorted the health insurance market.”
She added that Trump and Republicans are “currently coming up with creative solutions and ideas” to reduce health care costs, although she did not provide details.
The issue, polls show, has united many voters regardless of political affiliation.
One study released by KFF in November found that 74% of Americans support expanded ACA credits.
Some Republicans warn that failure to address the problem could cost them their legislative majority in next November's elections.
“If we defeat this health care bill, nothing else will matter,” Florida Republican Congressman John Rutherford told Politico.
