Opinion: Congress had eight months to fix the ACA subsidy cliff. It chose not to.

On Nov. 1, the federal health insurance marketplace opens for business again, and for the second year running, Americans shopping for individual coverage will find a bill that is substantially larger than the one they paid in 2025. This time they will also have less time to absorb the shock. Under a Trump administration rule finalized last year, open enrollment on HealthCare.gov now closes Dec. 15 rather than Jan. 15, cutting five weeks from the window consumers have to compare plans and act before a deadline. The compressed calendar would be a manageable inconvenience if the underlying affordability problem had been fixed. It has not. Congress has simply run out the clock on it, twice.

The enhanced premium tax credits that made Affordable Care Act coverage cheap for tens of millions of people expired on Jan. 1, 2026. Enacted in 2021 as pandemic relief and extended through 2022 legislation, the credits had let low-income enrollees pay nothing in premiums and capped costs for higher earners at 8.5% of income. Their lapse showed up immediately in the numbers: enrollment on HealthCare.gov and the state exchanges fell to 23.1 million for 2026, a 5% drop from the prior year, and the average annual premium paid by subsidized enrollees roughly doubled, from $888 to $1,904, according to the Centers for Medicare & Medicaid Services. None of this was a surprise. The Congressional Budget Office warned in September 2025 that letting the credits lapse would push premiums higher and reduce coverage; it separately estimated that making them permanent would cost $350 billion over a decade while extending coverage to 3.8 million more people. Lawmakers had the numbers in hand before the deadline passed.

A bill that already passed the House

What makes the current standoff harder to excuse than an ordinary legislative impasse is that one chamber has already acted. On Jan. 8, 2026, the House passed H.R. 1834, a three-year extension of the enhanced credits, by a vote of 230-196. Seventeen Republicans, many from competitive districts, crossed over to join every voting Democrat. That is not a razor-thin fluke; it is a working majority that exists today, eight months later, and has never been tested on the Senate floor. The bill was sent across the Capitol and effectively disappeared into the calendar.

Republican leaders have a coherent objection to the House bill, and it deserves to be stated plainly rather than waved away: a permanent or lightly conditioned extension is expensive, and the enhanced credits were designed in 2021 as temporary COVID-era relief, not a permanent entitlement. Some conservatives also point to enrollment-integrity problems — improper sign-ups, in particular — that the same CMS rule shortening the enrollment window was written to address, with the agency projecting it would save roughly $12 billion in 2026 by tightening verification. These are legitimate policy arguments. They are not, however, arguments against holding a vote. They are arguments for amending the bill — which is precisely what a bipartisan group of senators tried to do.

The compromise nobody brought to a vote

In December, Sens. Susan Collins of Maine and Bernie Moreno of Ohio introduced the CARE Act, a narrower answer built for exactly the objections Republican leadership had raised. It would extend the credits for two years rather than indefinitely, cap eligibility by income, and require a $25 minimum monthly premium to eliminate zero-cost plans that critics blame for enrollment fraud. "Families in Maine and across the country are struggling with the high cost of health care," Collins said in unveiling the proposal, adding that the bill would "help prevent unaffordable increases in health insurance premium costs for many families" while putting "a reasonable income cap on these subsidies."

"This bill would help prevent unaffordable increases in health insurance premium costs for many families by extending the Affordable Care Act enhanced premium tax credits for two years and putting a reasonable income cap on these subsidies to ensure they are going to the individuals who need them." — Sen. Susan Collins, R-Maine

The CARE Act was, on its face, a genuine attempt at the kind of moderated compromise congressional leaders say they want: time-limited, cost-conscious, targeted. Nine months after it was introduced, it has not received a floor vote either. Neither has any successor version. A December Senate vote on competing proposals — a straight extension and a Republican health-savings-account alternative — failed to reach 60 votes on either side, and talks since then have moved in fits of reported optimism without producing legislative text that leadership has scheduled for a vote.

A funding deal that left the question unanswered

The clearest evidence that this is a choice rather than an impasse came earlier this month. Facing the same Sept. 30 government-funding deadline that triggered a 43-day shutdown a year earlier, Congress passed a continuing resolution, and President Trump signed it into law on Sept. 2, funding agencies through Dec. 11. The bill passed the House 370-48 and the Senate 90-6 — overwhelming majorities in both chambers, assembled in days once leadership decided a shutdown was politically unpalatable ahead of the midterms. The subsidy fight that had driven the previous year's shutdown was left out of the deal entirely. If bipartisan majorities can be found quickly for funding legislation when leadership wants one, the absence of similar urgency on health premiums is a decision about priorities, not a reflection of what is achievable.

That decision now collides with the calendar. Insurers have proposed a median rate increase of roughly 14% to 15% for 2027 plans — the second-largest requested increase in nearly a decade — and are exiting the marketplace entirely in more than 20 states, according to industry and health-policy tracking cited by trade press covering the filings. Consumers will start seeing those numbers when enrollment opens Nov. 1, with five fewer weeks than in past years to switch plans, appeal an error or simply absorb the news before coverage lapses.

What a vote would actually cost

None of this requires Congress to agree that the enhanced credits should be permanent, or that cost concerns are illegitimate. It requires Congress to vote. A floor vote on H.R. 1834, the CARE Act or some blend of the two would let each side's argument be tested against actual support rather than presumed opposition — the same test the House already passed in January. Leadership in both parties has found reasons to avoid that test: for Senate Republicans, a vote before the midterms risks a visible defection on a bill with real bipartisan backing; for some Democrats, a scaled-back compromise with income caps is less useful as a campaign issue than an unresolved crisis. Both calculations treat inaction as costless. It is not. The cost lands on the 23 million people who already re-enrolled once this year under sticker shock, and on however many fewer sign up under a shorter window and higher prices this time. A Congress that can pass a 370-48 funding bill in 48 hours when it wants to is capable of scheduling a vote on the bill it has been sitting on since January. It has simply chosen not to.