Congressional lawmakers in Washington are preparing for a pivotal moment in health care policy this week as the Senate schedules votes on dueling measures aimed at addressing the impending expiration of enhanced premium tax credits under the Affordable Care Act.

The subsidies, expanded during the COVID-19 pandemic to make health insurance more affordable for millions of Americans, are set to lapse on December 31 unless lawmakers act — a development that has heightened urgency in both chambers of Congress.

On Thursday, the Senate is expected to take up two distinct proposals: Democrats are advancing legislation to extend the enhanced Affordable Care Act tax credits for three years, while Republican senators have rallied behind a counter-proposal that would phase out the subsidies and instead channel federal funds into health savings accounts.

The GOP alternative, led by Senators Bill Cassidy of Louisiana and Mike Crapo of Idaho, would provide annual contributions of up to $1,500 into tax-advantaged accounts for eligible enrollees, a plan framed by its supporters as delivering direct support to individuals and reducing costs for consumers.

President Donald Trump has publicly backed this approach, presenting it as part of a broader effort to ease health care expenses and return money directly to Americans.

Democratic leaders, including Senate Majority Leader Chuck Schumer, argue that extending the existing tax credits is essential to prevent sharp increases in premiums next year for the more than twenty-million people who rely on marketplace plans with enhanced subsidies.

They contend that without action, average premiums could surge and pose significant financial burdens on households — a concern underlined by recent health policy estimates.

Despite the prominence of both bills, neither is expected to secure the sixty votes needed to overcome a filibuster in the Senate, reflecting deep partisan divisions over the future of the Affordable Care Act and the best means of supporting health coverage.

If both measures fail, the issue may fall into early 2026, after lawmakers return from the holiday recess, potentially leaving millions to face a new year with higher costs and reduced assistance.

In the House of Representatives, bipartisan efforts are also underway to force floor votes on alternative approaches to extending subsidies, including proposals that would continue the enhanced credits for a shorter period or impose income caps and other adjustments.

However, Republican leadership in the House has largely resisted prioritising long-term subsidy extensions, complicating a unified legislative response.

As the clock ticks toward the end-of-year deadline, lawmakers from both parties continue to debate the merits of their respective proposals, aware that the outcome will have profound implications for the health insurance market, coverage affordability and the broader national debate over health care policy in the United States.