The Waiting Room | Your Year-End Healthcare Update: Where the Fight for ACA Tax Credits Stands

Over the hump and through the wood chipper ...

Greetings, Lincoln Square readers! Welcome to the last Waiting Room of 2025!

When we left off two weeks ago, both House and Senate Republicans were busily slapping together various half-assed, half-baked “healthcare reform bills” to offer up as alternatives to the clean 3-year extension of the enhanced ACA tax credits being pushed by unified House & Senate Democrats.

In the end, Senate Republicans settled on one of the worst of the bunch: The appropriately-named “Crapo Bill” (ok, technically it was the Cassidy-Crapo bill after GOP Sen. Bill Cassidy of Louisiana & GOP Sen. Mike Crapo of Idaho), which would have done a lot of terrible things without actually, y’know, extending the damned tax credits.

Well, the Big Day came in the Senate…and, exactly as expected, both the Democrats’ clean three-year extension and the Republicans Crapo bill ended up failing to hit the 60-vote threshold necessary to advance: Four GOP Senators voted for the Dems’ bill and one voted against the GOP bill, resulting in each getting an identical 51-48 result.

Meanwhile, House Republicans came up with a half-dozen variants of bills to try and save face with. Some had bipartisan support, others didn’t.

And for a brief period of time, it looked like House GOP leadership was going to allow one of the more reasonable ones to be tacked onto an otherwise terrible “main” bill.

In the end, though, that agreement fell apart, meaning the House GOP is instead about to vote on just the main bill … which includes several terrible provisions which would actually result in even more people losing healthcare coverage.

BUT WAIT…!

This, in turn, infuriated several “moderate” (a.k.a. “vulnerable swing district”) House Democrats so much that on Wednesday morning, four of them actually signed onto the Democrats discharge petition to force a House vote on a clean three-year extension of the enhanced tax credits after all!

So, where does that leave things for, y’know, all ~24 million or so actual ACA enrollees?

Well, first of all, while all of the above insanity was going on, the initial 2026 ACA Open Enrollment Period deadline came and went in most states on December 15th.

It’s important to remember that there’s some important caveats to this:

• If you live in IDAHO, Dec. 15 was the one and only Open Enrollment Period deadline.

• In MASSACHUSETTS, you still have until Dec. 23 to enroll for coverage starting January 1st

• In CA, IL, MD, NV, NJ, NM, PA, RI or VA, you still have until Dec. 31 to enroll for coverage starting January 1st.

• If you live in any state (except ID) and either missed/miss the deadline entirely or don’t like the plan that you were auto-renewed into, you still have until at least January 15th to enroll or to switch plans.

I would once again STRONGLY urge you to read my UPDATED ACA Enrollment Guide for all of the deadlines (which vary from state to state) as well as a ton of other important information about Open Enrollment.

As for the House vote, that likely won’t happen until sometime in January. Assuming it passes, it would then be kicked back over to the Senate, where GOP Majority Leader Thune may or may not bother even bringing it up for another vote…and even if he does, it’s extremely unlikely to reach the 60 vote cloture threshold just a month or so after only getting 51 votes.

But … you never know.

P.S. Earlier this week I also joined Lincoln Square’s Susan J. Demas & Sam Osterhout on their Weekly Assignment show to discuss the latest insanity.

---

---

P.P.S. Oh yeah … in the middle of all this, the U.S. Centers for Medicare & Medicaid Services posted their initial “snapshot” Open Enrollment Report, with around 5.8 million people having enrolled in the first several weeks of November.

P.P.P.S. Meanwhile, House Republicans (including all four of the so-called “moderates” who signed onto the Dems’ three-year extension) went ahead and passed the main bill which would do three nominal things (PBMs & ICHRAs & Stop-Loss plans) and two harmful things (Association Plans & CSR reimbursements). Hopefully this bill will go nowhere in the Senate.

Good luck to us all. Happy holidays and I’ll see you again in January … which will be after the initial enrollment deadline for January coverage in every state.