Opinion: Congress Had Nine Months to Fix Health-Insurance Premiums. It Still Hasn't.

In five weeks, on Nov. 1, the federal insurance marketplace opens for 2027 coverage. The Centers for Medicare & Medicaid Services has confirmed the window will run through Jan. 15, after a federal court blocked an earlier plan to shorten it. What CMS cannot confirm is what most enrollees will actually pay, because the Senate has spent nine months sitting on a fix that already cleared the House with Republican votes.

The enhanced premium tax credits that helped roughly 22 million marketplace enrollees afford coverage expired on Dec. 31, 2025, after Congress failed to renew them. The Senate tried first and failed: a December vote to extend the credits for three years drew 51 votes, four short of the 60 needed, though four Republicans — Susan Collins of Maine, Josh Hawley of Missouri, and Lisa Murkowski and Dan Sullivan of Alaska — broke with their party to support it. Then, in a rare rebuke of House leadership, a bipartisan group of lawmakers forced a floor vote using a discharge petition, and on Jan. 8 the House passed its own three-year extension, H.R. 1834, by a vote of 230 to 196, with 17 Republicans joining every Democrat.

That bill has gone nowhere since. There has been no Senate floor vote on H.R. 1834 in the eight months since the House acted, even though the raw arithmetic has not changed much: Democrats plus the same four Senate Republicans who voted for a similar extension in December would put supporters within reach of a genuine floor fight, if leadership chose to schedule one.

This is not a case where the cost or consequences are unknown. The Congressional Budget Office's own estimate of H.R. 1834 found the bill would add about $80.6 billion to the deficit over the coming years while increasing the number of people with health insurance by roughly 4 million by 2028. Lawmakers can reasonably disagree about whether that trade-off is worth making. What is harder to defend is going another full plan year without forcing that debate to a vote, while insurers set rates and households make coverage decisions in the dark.

Those decisions are not abstract. Marketplace premiums are projected to rise by a median of roughly 15 percent nationally for 2027, with increases ranging from under 7 percent in states like Vermont and Utah to about 29 percent in Arizona, according to an analysis compiled from state insurance filings. Out-of-pocket maximums are set to climb again, to $12,000 for an individual, up from $10,600 this year. Insurers have also been exiting marketplaces in more than 20 states, narrowing choices in exactly the places where affordability pressure is already worst.

A vote is not a favor

Senate leaders of both parties have reasons to avoid a floor vote: Republican leadership does not want to force members to choose between their party and a politically painful premium spike back home, and some Democrats may prefer campaigning on the issue to actually resolving it before the midterms. Neither motive serves the roughly 22 million Americans who bought coverage assuming some version of the subsidy structure that has existed since 2021 would still be in place.

The House has already done the harder political work, twice over — first through a discharge petition that bypassed its own leadership, then in a floor vote that cost Republican members real intraparty friction. The CBO has already priced the bill. Four Senate Republicans have already been on record supporting a version of it. What is missing is a scheduled vote, not a solution. With open enrollment five weeks away, the Senate does not need a new idea. It needs to bring up the one already sitting in its inbox and let members go on record before their constituents start shopping for a plan they may no longer be able to afford.