By Natalie Andrews, Siobhan Hughes and Lindsay Wise

WASHINGTON -- Republicans have yet to coalesce around a healthcare strategy just days before an expected vote on extending enhanced Obamacare subsidies, triggering concerns from some GOP lawmakers about a voter backlash.

The Senate is expected to vote this week on a Democratic-backed measure to extend the enhanced healthcare subsidies for three years. Senate Republican leaders agreed to hold the vote as a condition for ending the government shutdown.

The Democratic proposal isn't expected to pass, heightening the risk that the subsidies will expire and millions of people will see their healthcare costs rise starting next month. Republicans haven't yet united around an alternative proposal, as they struggle with how -- or whether -- to extend the subsidies and address issues that animate conservative such as healthcare fraud.

Some Republican lawmakers are increasingly concerned that healthcare is a political vulnerability for many in the GOP, who campaigned for years on repealing the Affordable Care Act, but haven't agreed on a healthcare plan of their own.

"America is ready to see what Republicans are for," said Republican Sen. Roger Marshall of Kansas.

"If we don't have a good economy next November and we don't have the American dream start to be restored, we're going to lose," warned Marshall, a physician. On Monday, he is planning to introduce "The Marshall Plan Act," adding to the growing list of healthcare-related ideas floating around Capitol Hill.

His plan would extend the enhanced Obamacare subsidies for one year, limit healthcare fraud, introduce more price transparency into healthcare and eventually transition to health savings accounts, which President Trump and other Republicans support.

Retiring Republican Sen. Thom Tillis said the race for his North Carolina Senate seat would be even more at risk of falling into Democratic hands if Republicans fail to reach agreement on a plan for addressing healthcare. "The Democrat strategists have got to be thinking about all the sympathetic stories that they're going to march out, beginning in the first quarter of next year, if we don't get it done," Tillis said.

Retiring Rep. Don Bacon (R., Neb.) said that if Republicans can't agree on a healthcare plan, "it's political malpractice."

The subsidies at the center of the healthcare debate were first enacted in 2021 during the pandemic and have attracted millions of new people into Obamacare's individual marketplace. Unless Congress acts, hundreds of thousands of middle-income people will fall off a "subsidy cliff" and lose the benefit entirely. Lower- and moderate-income people will still receive a subsidy, but the size will revert to prepandemic levels, making their costs increase.

Abortion policy is another sticking point in the healthcare discussions. Under current law, users have to pay a nominal fee to get abortion coverage in ACA insurance, but antiabortion groups such as Susan B. Anthony Pro-Life America want GOP lawmakers to push for further restrictions.

Republican candidates underperformed in elections last month in Virginia and New Jersey, prompting concerns that the GOP could face even steeper losses in next year's midterm elections if they don't focus on the cost of living. Voters have cited concerns about the high prices in recent national polls.

Trump's advisers had been discussing options for a Republican healthcare proposal after the president recently revived his longstanding push to replace Obamacare. Trump's team had discussed extending the subsidies temporarily, while imposing income caps for ACA enrollees to qualify, as well as measures to crack down on healthcare fraud

But the president hasn't released a proposal amid disagreements among Republicans over how to proceed. Speaker Mike Johnson (R., La.), who has a razor-thin majority in the House, cautioned the White House last month that most House Republicans don't have an appetite for extending the enhanced healthcare subsidies. Johnson is expected to introduce a healthcare plan for a vote later this month.

A group of nearly three dozen Democrats and Republicans, including several facing tough re-election fights next year, have pitched a plan that would extend the subsidies for one year and commit to making a new bipartisan plan on healthcare by mid-2026. They are writing legislative text in preparation for introducing the bill.

Rep. Brian Fitzpatrick (R., Pa.), who is talking to Democrats and Republicans as well as White House officials, said he is planning to soon release a bipartisan bill extending the subsidies for two years, but making them available only to people below a certain income level and requiring everyone to pay at least something. His measure also envisions eventual more widespread reliance on health savings accounts, which allow people to sock away money tax-free to use later for healthcare.

Sen. Rick Scott (R., Fla.) has introduced a plan to create "Trump Health Freedom Accounts." The plan would redirect money from the subsidies to savings accounts that could be used to pay for healthcare costs. That plan was backed by the Republican Study Committee, of which more than half of House Republicans are members.

Scott doesn't support extending the ACA enhanced subsidies but acknowledged that if Republicans can't lower costs on healthcare, housing and food, they will face repercussions. "Eventually it's going to show up in elections. The poor are going to say screw this, this hasn't worked, I want somebody that is going to fix the problems," Scott said.

Some Republican lawmakers have said they want Trump to become more involved in the discussions, in hopes that he can bring the party together.

Trump last week said the money used for the subsidies should "go to the people and then let the people go out and buy their own healthcare." He said he was negotiating with Democrats, though Senate Minority Leader Chuck Schumer (D., N.Y.) and others said detailed talks with the White House weren't happening.

The Democratic-backed healthcare measure, which is expected to get a vote on Thursday, isn't likely to garner enough support to pass the Senate, which has a 60-vote threshold to approve most bills. If Democrats' proposal fails, Republicans are still weighing whether they will put forward a plan of their own for a vote, people familiar with the discussions said.

"We haven't decided yet exactly what we're going to do," Senate Majority Leader John Thune (R., S.D.) said Thursday.

Write to Natalie Andrews at natalie.andrews@wsj.com, Siobhan Hughes at Siobhan.hughes@wsj.com and Lindsay Wise at lindsay.wise@wsj.com

(END) Dow Jones Newswires

December 08, 2025 05:30 ET (10:30 GMT)

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