January 15, 2026 was the last day for individuals to enroll in a Marketplace plan (outside of a Special Enrollment Period), and Congress has not enacted any legislation to stop the premium hikes that went into effect on January 1, 2026. As discussed in earlier Policy Infusion updates on the future of enhanced ACA subsidies, debate over how to handle these expiring subsidies has dragged on for months.
House Approves Three-Year Extension While Senate Negotiations Continue
On January 8, the House passed legislation to extend enhanced Affordable Care Act (ACA) tax credits, which reduce monthly insurance costs for individuals who purchase coverage through the Marketplace. These credits expired at the end of 2025, resulting in an average 26% increase in ACA premiums for millions of Americans in 2026.
Although House Speaker Mike Johnson opposed the measure, the three-year extension advanced after a bipartisan group of legislators used a procedural tool known as a discharge petition to force the bill to the floor. Discharge petitions allow a majority of House members to sidestep leadership and trigger a vote on a bill, a rare step typically reserved for issues with broad bipartisan backing. Seventeen Republicans joined all Democrats in voting for the bill. Many of these Republicans represent swing districts and/or areas with high ACA enrollment, demonstrating growing concern about health care costs as a key issue heading into the midterm elections.
In the Senate, however, the House-passed extension is unlikely to reach the 60-vote threshold required for passage. Lawmakers there, including GOP Sens. Bernie Moreno of Ohio and Susan Collins of Maine, as well as Democratic Sens. Jeanne Shaheen and Maggie Hassan of New Hampshire, are instead exploring a narrower bipartisan deal. Their proposal, which has yet to be released, would reportedly extend the enhanced subsidies for two years, reopen ACA plan enrollment through March 1, and include several policy changes, such as income limits for subsidy eligibility, a small mandatory minimum premium for all plans, and the reinstatement of cost-sharing reductions that lower expenses for both patients and the federal government. Despite these efforts, significant disagreements persist, especially among Republicans who oppose the enhanced subsidies altogether. The group has postponed releasing the text of this legislation until the end of January.
What Comes Next?
Whether ACA subsidies will be extended (and in what form) remains uncertain. Still, health care affordability continues to be a major sticking point on Capitol Hill. On January 22, the House Energy & Commerce Committee and the Ways & Means Committee, both of which play major roles in shaping health care policy, will hold back-to-back hearings featuring testimony from five CEOs of the nation’s largest insurance companies. Note: the Infusion Access Foundation is collecting patient experiences with insurance denials to share with the committees, click here to make your voice heard by Congress!
Republicans, who control the committees and set their agendas, are expected to use the hearings to criticize the ACA and promote alternative policy ideas. Some have even suggested pursuing a second, health-focused reconciliation package, despite increasingly razor-thin margins following the recent passing of California Republican Doug LaMalfa. Democrats, meanwhile, are likely to press insurers on affordability concerns and renew calls to extend the ACA subsidies.
How You Can Take Action
The House’s passage of a three-year extension signals that, despite political hurdles, there is meaningful support in Congress for maintaining policies that help millions of Americans afford health coverage. At moments like this, sustained advocacy can have real impact.
As Senate negotiations continue, please consider taking a few minutes to contact your members of Congress by sending a letter here.