Like millions of Americans this week, lawmakers will be returning from a holiday break and will be working through a pile of leftovers. But for lawmakers, it won’t be turkey sandwiches and pumpkin pie; it will be negotiations over continuing the enhanced
The Administration
President Trump made waves before Thanksgiving by teasing a potential two-year extension of enhanced APTCs with changes in eligibility requirements. However, after reportedly receiving a cold reception from Capitol Hill conservatives and an outright rejection from House Democratic health care leaders, President Trump left town. As he did, the President told reporters that he’d prefer not to extend the tax credits at all, but some kind of extension may be needed. This has left congressional Republicans without a clear understanding of the President’s position at a time when they are divided on how to move forward on this issue.
Meanwhile, the tragic shooting of two National Guard members in the heart of DC, has caused President Trump to pivot towards non-health care issues. President Trump is now calling for additional National Guard troops to be deployed to the District and for green card applications to be reviewed since the alleged shooter was an Afghan refugee.
The Senate
As turkey is finished and holiday music fills the air, senators on both sides of the aisle are discussing the enhanced APTC issue with care. Senate Majority Leader John Thune (R-SD) promised Senate Democrats a vote on legislation of their choice to extend the tax credits in exchange for reopening the government. However, Republican health care leaders in the Senate, such as HELP Committee Chair Bill Cassidy (R-LA), have been pushing for a GOP health care reform bill that would redirect enhanced APTC funding to tax-free accounts. This idea is popular with President Trump and congressional
We expect Sen. Cassidy to continue pressing to redirect the APTC funding to tax-free accounts when he presides over a HELP Committee hearing on December 3 on rising health care costs. Senate Finance Committee Democrats opposed this idea during a November 19 hearing on health care costs, and Ranking Member Ron Wyden (D-OR) even published a report criticizing the proposal.
The hearing will feature an ideological battle with the president of the Council for Affordable Health CoverageCouncil for Affordable Health Coverage, which advocates for lowering health care costs through marketplace principles, pitted against the national coordinator of the progressive Physicians for a National Health Program.
On a “clean extension” of current policy on APTCs, Sen. Jeanne Shaheen (D-NH) has said she has “had constructive conversations” with Republican senators about extending the enhanced APTCs. Certain GOP senators, such as Sens. Susan Collins (R-ME), Thom Tillis (R-NC), and Lisa Murkowski (R-AK), have expressed support for extending the enhanced APTCs, although for differing lengths of time and with differences in what changes (such as restricted income eligibility requirements) they would need to see. Notably, both Sens. Collins and Murkowski are on the Senate HELP Committee.
We are also keenly watching for the Senate Appropriations Committee to make moves this week on a minibus of appropriations legislation, which could include the Labor-HHS funding bill.
The House
Any discussion of how to finish the leftovers on the congressional health care policy plate will need to include more than just the Senate. House Speaker Mike Johnson (R-LA) has yet to commit to voting on legislation to extend the enhanced APTCs and has said that House Republicans have little interest in doing so. But that doesn’t mean things aren’t happening in the lower chamber.
House Democratic leadership has filed a discharge petition to force Speaker Johnson to vote on legislation to extend the enhanced APTCs for three years. To force a vote on the legislation, six Republicans would need to join the current 212 Democrats on the discharge petition to reach the required 218 signatories. This would be a tough lift, but a handful of moderate House Republicans and those at risk of losing their seats in 2026 have voiced support for a one-year extension of the enhanced APTCs.
If House Democrats would file a discharge petition on a shorter-term extension, they may find the votes needed to force a vote on such a bill. Key Republicans to watch include Reps. Jen Kiggans of Virginia, Young Kim and David Valadao of California, Jeff Hurd of Colorado, Tom Kean of New Jersey, Juan Ciscomani of Arizona, and Mike Lawler of New York.
The House is also set to consider a couple of other health care bills this week under suspension of the rules. The first of these bills, H.R.4313, the Hospital Inpatient Services Modernization Act, would reauthorize the hospital-at-home waiver for five years. The second bill, H.R.1262, the Give Kids a Chance Act, would expand the Food and Drug Administration’s authority with respect to research on rare pediatric diseases and renew the Pediatric Rare Disease
Outside Washington, voters in Tennessee’s 7th congressional district will head to the polls on December 2 for a special election to replace the recently retired Rep. Mark Green. Despite being a district that President Trump carried by more than 20 points, the polling has been surprisingly close. It will be important to keep an eye on this and other upcoming special elections as Speaker Johnson continues to deal with a very thin majority ahead of what could be a very difficult midterm election.
House Health Care Hearings this Week
- December 2: House Ways and Means Oversight Committee hearing on Organ Procurement Organizations
- December 3: House VA Committee Legislative hearing, including the Guard Veterans’ Health Care Act
And don’t forget, the Medicare Payment Advisory Commission is meeting December 4-5 with a packed agenda. We missed ya – glad you’re back!
There You Have It
We’ve officially entered the holiday season, and our team at Chamber Hill Strategies will be kicking it off by visiting Winter Wonderfest at Nationals Park! How are you celebrating the holiday season? Let us know. Make it a great week!