The Senate Finance Committee held a hearing on Nov. 19 titled “The Rising Cost of Health Care: Considering Meaningful Solutions for All Americans,” which focused on the challenges posed by the expiration of the enhanced premium tax credits (EPTCs), which provide increased financial assistance to purchase health insurance through the Affordable Care Act (ACA) Marketplaces and other policy mechanisms to ensure access to affordable health insurance coverage. The EPTCs, established under the American Rescue Plan Act of 2021 (P.L. 117-2, PDF), are due to expire at the end of 2025 and the extension of the tax credits remains a central priority for Democrats. Earlier this year, disagreements about whether and how to address the expiring subsidies contributed to a funding impasse and government shutdown when Senate Democrats refused to vote for a spending package that did not address this issue [refer to Washington Highlights, Oct. 3].
The hearing revealed ideological differences between Republicans and Democrats over how to address the affordability challenges created by the expiration of the EPTCs. In his opening statement, Chair Mike Crapo (R-Idaho) asserted that the ACA has not made health insurance more affordable, with subsidies masking year-over-year premium increases in the marketplaces. Several committee members — including Crapo and Sen. Bill Cassidy (R-La.) MD, who also chairs the Senate Health and Human Services, Education, Labor, and Pensions Committee — expressed support for redirecting federal dollars directly to consumers through Health Savings Accounts (HSAs), a proposal backed by President Donald Trump.
Committee Democrats pushed back against this proposal, arguing that it would not meaningfully reduce premiums for the 2026 plan year, while pushing Americans into high-deductible plans that lack comprehensive coverage. In his opening statement, Ranking Member Ron Wyden (D-Ore.) emphasized these concerns, arguing that while HSAs “can be useful tools for some consumers ... they are not a replacement for comprehensive health insurance.”