# The ACA Subsidies Fight Hits the House Floor

An episode of [Big Take](https://invisiblenetwork.ai/podcast/1578096201), 7 Jan 2026, 14 min.

Audio: https://podtrac.com/pts/redirect.mp3/tracking.swap.fm/track/UVBrz8bN8aM2Xe47PEPu/traffic.omny.fm/d/clips/e73c998e-6e60-432f-8610-ae210140c5b1/825d4e29-b616-46f4-afd7-ae2b0013005c/7c6d119d-c903-4134-bc18-b3cb0122c799/audio.mp3?utm_source=Podcast&in_playlist=8b1dd624-a026-43e9-8b57-ae2b00130066

The US House of Representatives will vote today on whether to extend subsidies for the Affordable Care Act that bring down health care costs for millions of Americans. The subsidies expired at the end of December, and lawmakers returned to Capitol Hill after their winter break just as divided over the issue as they were before the holidays. On today’s Big Take podcast, Bloomberg Congress reporter Caitlin Reilly joins host David Gura to discuss the sticking points between Republicans and Democrats and where that stalemate leaves Americans who rely on ACA subsidies in the final weeks of open enrollment. Read more: House Backs Renewing Health Subsidies, Defying Republican Leaders Hosted by David Gura Produced by Julia Press Reported by Caitlin Reilly Edited by Tracey Samuelson Fact-checking by Eleanor Harrison-Dengate Engineering by Alex Sugiura Senior Producer: Naomi Shavin Deputy Executive Producer: Julia Weaver Executive Producer: Nicole Beemsterboer See omnystudio.com/listener for privacy information.

## Transcript

[0:02] Speaker 1: Bloomberg Audio Studios, podcasts, radio news.
[0:10] Speaker 2: It's a new year, but lawmakers are having the same
[0:13] Speaker 2: old fight over Affordable Care Act subsidies. The House of
[0:16] Speaker 2: Representatives is expected to vote today on a three year
[0:19] Speaker 2: extension of pandemic era subsidies that lowered the cost of
[0:22] Speaker 2: insurance for millions of Americans, a proposal that already failed
[0:26] Speaker 2: in the US Senate. Those subsidies expired at the end
[0:29] Speaker 2: of December, and now a new deadline looms. Americans looking
[0:33] Speaker 2: to purchase an ACA plan only have until January fifteenth
[0:37] Speaker 2: in most states to choose their insurance for the year ahead.
[0:40] Speaker 2: Without the subsidies, those plans are a lot less affordable.
[0:44] Speaker 1: The rates are now currently up on average, they're expected
[0:48] Speaker 1: to about double. That varies greatly depending on your age
[0:53] Speaker 1: and where you live, how much healthcare is available in
[0:56] Speaker 1: your area. That's sort of saying.
[0:58] Speaker 2: Bloomberg's Caitlin Riley covered Congress and she's been tracking the
[1:01] Speaker 2: policy debate and the impact it could have on Americans.
[1:05] Speaker 1: About twenty four million people are enrolled in the ACA.
[1:09] Speaker 1: Upwards of ninety percent of those people got these enhanced
[1:13] Speaker 1: premium subsidies that went into place during the pandemic.
[1:17] Speaker 2: Now, many Americans are trying to figure out what insurance
[1:20] Speaker 2: they can afford. The rising costs are expected to result
[1:23] Speaker 2: in nearly four million people losing healthcare over the next decade,
[1:27] Speaker 2: according to the Congressional Budget Office.
[1:29] Speaker 1: What I've gotten from people I've spoken to is just
[1:31] Speaker 1: a tremendous amount of anxiety and anguish. People seem to
[1:36] Speaker 1: be really putting off making a decision because they have
[1:39] Speaker 1: only very bad options.
[1:43] Speaker 2: One person Caitlin spoke with is Carrie van Mevrin. Carrie
[1:46] Speaker 2: owns a management consulting business in Missouri. She's done a
[1:49] Speaker 2: lot of work for state and local governments, and small
[1:52] Speaker 2: business owners like Carrie are disproportionately reliant on the Obamacare subsidies.
[1:56] Speaker 3: I'm fifty four, I have a history of blood class.
[2:00] Speaker 3: Last time that I was in the er, if I
[2:02] Speaker 3: hadn't had insurance, would have been thirty thousand dollars and
[2:05] Speaker 3: that was just an ER visit.
[2:07] Speaker 2: Harry has decided to re enroll in ACA coverage for
[2:10] Speaker 2: twenty twenty six, but without the guarantee of those subsidies,
[2:14] Speaker 2: she's had to choose a new plan with higher monthly premiums.
[2:17] Speaker 3: I ended up picking a very high deductible, a plan
[2:21] Speaker 3: that has much higher copays, it has much higher out
[2:25] Speaker 3: of pocket max. So it becomes a risk policy, not
[2:29] Speaker 3: a healthcare policy, because you can't afford to use it.
[2:34] Speaker 2: Even as lawmakers face the end of open enrollment next week,
[2:37] Speaker 2: my colleague Kaitlin Riley says, it remains uncertain whether Democrats
[2:41] Speaker 2: and Republicans can reach a compromise.
[2:44] Speaker 1: All of this is still very much a long shot,
[2:47] Speaker 1: but we are expecting to see more activity in the
[2:50] Speaker 1: coming weeks. And even if all of that fails, because
[2:55] Speaker 1: it's a midterm election year, we don't expect this issue
[2:58] Speaker 1: to go away.
[3:03] Speaker 2: I'm David Gera, and this is the big take from
[3:05] Speaker 2: Bloomberg News today. On the show, how an intractable battle
[3:09] Speaker 2: over how to lower health care costs could wind up
[3:12] Speaker 2: keeping them high. When the calendar flipped to twenty twenty six,
[3:23] Speaker 2: the cost of health insurance jumped from millions of Americans.
[3:27] Speaker 2: The average premium is expected to increase one hundred and
[3:30] Speaker 2: fourteen percent this year, according to KFF, that's a non
[3:33] Speaker 2: partisan health research organization.
[3:35] Speaker 1: It's a lot of people who are affected by this.
[3:39] Speaker 1: It's about seven percent of the total population, though that's
[3:43] Speaker 1: not evenly distributed. Enrollments really high in red states, typically
[3:49] Speaker 1: in the South that didn't expand Medicaid under the Affordable
[3:53] Speaker 1: Care Act. So that's kind of the mix of people
[3:56] Speaker 1: we're seeing affected, and I think it's important to distinguish.
[3:59] Speaker 1: There are two sets of subsidies. The first set of subsidies,
[4:02] Speaker 1: which helps people on the lower income side of the scale,
[4:05] Speaker 1: went into place when the law was established. Those will
[4:08] Speaker 1: remain in place. The subsidies that we're typically talking about
[4:12] Speaker 1: when we talk about this are a set of tax
[4:13] Speaker 1: credits that were enacted during the pandemic by Democrats, and
[4:19] Speaker 1: those are allocated to the insurance companies in these exchanges
[4:24] Speaker 1: to keep premiums lower. For people making less than four
[4:29] Speaker 1: times the poverty level. This lowered costs further for them.
[4:33] Speaker 1: That subset of people we're already getting subsidies will continue
[4:37] Speaker 1: to get some subsidy, it's just a less generous subsidy.
[4:40] Speaker 1: It made a huge difference for anyone making more than
[4:43] Speaker 1: four times the poverty level, which in twenty twenty five
[4:46] Speaker 1: was I think around sixty three thousand dollars a year
[4:48] Speaker 1: if you're a single individual. For that group of people,
[4:51] Speaker 1: these subsidies are entirely going away, and it creates that Cliff,
[4:56] Speaker 1: and those are the people who are going to see
[4:58] Speaker 1: like the most drastic increase in their premium costs.
[5:02] Speaker 2: Caitlyn, when you're on Capitol Hill talking to Republican lawmakers,
[5:06] Speaker 2: what is the argument that they have been making for
[5:09] Speaker 2: why they're targeting these subsidies, why they've been in favor
[5:13] Speaker 2: of their expiration.
[5:14] Speaker 1: The big sort of ideological, principled argument they make is
[5:18] Speaker 1: that by creating the subsidy that it's actually driven healthcare
[5:21] Speaker 1: costs up. You remove kind of the competitive pressure that
[5:25] Speaker 1: might have exercised some moderating force on what these premiums cost.
[5:31] Speaker 1: So that's kind of the big ideological argument. I think
[5:34] Speaker 1: there's another piece of this that when Obamacare was created,
[5:38] Speaker 1: very few of them supported it. It's not become that
[5:41] Speaker 1: much more popular with them since these subsidies were created
[5:46] Speaker 1: fully along party lines, with only Democratic votes, and I
[5:51] Speaker 1: think there's a feeling that this was a temporary program
[5:54] Speaker 1: put in place during the pandemic or out of the pandemic.
[5:58] Speaker 1: And I think another piece the vices that they don't
[6:01] Speaker 1: like the cost. There are a lot of reasons that
[6:04] Speaker 1: come up, but I think it's like, really just this
[6:07] Speaker 1: deep sort of ideological divide between the parties on healthcare
[6:11] Speaker 1: and how to keep costs down.
[6:14] Speaker 2: Republicans argue the subsidies are too expensive. Since twenty twenty one,
[6:18] Speaker 2: they've driven up Obamacare's costs, and extending them for a
[6:21] Speaker 2: decade would cost more than three hundred billion dollars according
[6:25] Speaker 2: to the Committee for a Responsible Federal Budget, a nonpartisan
[6:27] Speaker 2: fiscal policy organization. President Trump supports an alternative that doesn't
[6:32] Speaker 2: involve ACA subsidies.
[6:34] Speaker 1: Back in November, there was sort of a trial balloon
[6:38] Speaker 1: that got put out seemingly from the White House that
[6:41] Speaker 1: would have involved a partial extension, like at least a
[6:45] Speaker 1: short term extension of the credits, and then like a
[6:48] Speaker 1: shift to like federally funded hsas that would go directly
[6:53] Speaker 1: two people enrolled in the exchanges.
[6:55] Speaker 2: Hsas health savings accounts. President Trump promoted the idea again
[7:00] Speaker 2: in a speech to Republican House members this week.
[7:02] Speaker 4: Let the money go directly to the people. It goes
[7:07] Speaker 4: in a healthcare account. It does. There are numerous things
[7:10] Speaker 4: you can do, but you have to let no money
[7:13] Speaker 4: for the insurance companies.
[7:14] Speaker 1: You know, I'm going to meet with the Republicans in
[7:16] Speaker 1: the Senate have put that plan forward, held a vote
[7:19] Speaker 1: on the floor. It needed sixty Obviously it didn't get there.
[7:22] Speaker 1: That is not going to go anywhere with Democrats if
[7:25] Speaker 1: it's proposed as like instead of the tax credits, they
[7:29] Speaker 1: like the tax credits.
[7:31] Speaker 2: Caitlin says, big picture, the two sides are just very,
[7:34] Speaker 2: very far apart.
[7:35] Speaker 1: I do think that like the politics here are probably
[7:40] Speaker 1: the bigger challenge to overcome in terms of reaching a
[7:43] Speaker 1: compromise versus like any single provision we're seeing in some
[7:48] Speaker 1: of the bipartisan proposals that have been put.
[7:51] Speaker 2: Out coming up the sticking points making a deal so difficult,
[7:55] Speaker 2: and why extending or changing the subsidies at this point
[7:58] Speaker 2: could create a new set of challenges. Bloomberg's Kaitlin Riley says,
[8:13] Speaker 2: the ideological divide we were just talking about, the vastly
[8:16] Speaker 2: different approaches to healthcare by Republicans and Democrats, is making
[8:19] Speaker 2: it hard for politicians to compromise within.
[8:22] Speaker 1: The center of both parties. I think you could get
[8:25] Speaker 1: to a place that's like a three year extension, maybe
[8:28] Speaker 1: a straight extension in the first year, maybe some income caps,
[8:31] Speaker 1: maybe some minimum premium payment that would get rid of
[8:34] Speaker 1: what Republicans see as like a gateway to a lot
[8:37] Speaker 1: of fraud within the system, which is people signing like
[8:40] Speaker 1: not realizing they've been signed up for really poor care
[8:43] Speaker 1: that costs nothing, and then having like brokers and insurance
[8:47] Speaker 1: companies continue to collect the subsidy.
[8:49] Speaker 2: But Caitlin says, just like the majority of Republicans don't
[8:52] Speaker 2: want to see these subsidies extended under any circumstance, many
[8:55] Speaker 2: Democrats are also taking a firm line.
[8:58] Speaker 1: I think there are a lot of Democrats rats who
[9:00] Speaker 1: feel that they're winning the political debate on this and
[9:06] Speaker 1: it's resonating with voters and feel like we want to
[9:09] Speaker 1: clean extension or we want missing.
[9:11] Speaker 2: Another key issue that could become a sticking point is abortion.
[9:15] Speaker 2: Many Republicans want of ban insurance plans that cover abortion
[9:18] Speaker 2: from receiving potential ACA subsidies. Most Democrats do not, and
[9:23] Speaker 2: even President Trump encouraged Republicans to be flexible on abortion
[9:27] Speaker 2: in a speech on Tuesday.
[9:29] Speaker 4: You gotta be a little flexible. You gotta work something.
[9:32] Speaker 4: You got to use ingenuity, you gotta work.
[9:36] Speaker 2: Four House Republicans did cross party lines to force a
[9:39] Speaker 2: vote on the Democrats proposed three year extension. That vote
[9:42] Speaker 2: is expected to take place today. A question of mechanics.
[9:46] Speaker 2: If Congress were at this point to renew these subsidies,
[9:50] Speaker 2: how would that impact existing twenty twenty six plans and
[9:54] Speaker 2: people who are maybe still trying to catch the end
[9:56] Speaker 2: of the open and Roman period right now.
[9:58] Speaker 1: I do think we're entering into period of where it
[10:00] Speaker 1: becomes a real logistical challenge. I believe that a lot
[10:05] Speaker 1: of exchanges and insurance companies had plans in place in
[10:08] Speaker 1: case there had been a clean extension. One criticism we've
[10:11] Speaker 1: heard from Democrats of a bipartisan compromise that makes changes
[10:16] Speaker 1: is that, like, it would just create such a logistical
[10:19] Speaker 1: nightmare if now you're adjusting to a subsidy that looks
[10:23] Speaker 1: different than the one that just expired. And even from
[10:27] Speaker 1: some moderate Republicans who seem interested in reaching a deal,
[10:32] Speaker 1: you have seen some acknowledgment that, like, maybe for the
[10:36] Speaker 1: first year you would just extend them as is and
[10:38] Speaker 1: then phase in modifications later. What likely would have to
[10:43] Speaker 1: happen if they reach a bipartisan compromise certainly after January fifteenth,
[10:47] Speaker 1: and a lot of the plans that have percolated include
[10:50] Speaker 1: this is you would see some extension of the open
[10:52] Speaker 1: enrollment period to allow for people to get better coverage
[10:59] Speaker 1: or sign up for like you would probably have to
[11:02] Speaker 1: see some change to open enrollment to accommodate this.
[11:07] Speaker 2: We're at a moment where lawmakers are looking headlong at
[11:10] Speaker 2: another budget fight, just weeks away from the prospect of
[11:13] Speaker 2: another government shutdown. Do you have any sense of whether
[11:16] Speaker 2: or not these sub seats could become a sticking point
[11:18] Speaker 2: in that next big spending fight, or are lawmakers from
[11:22] Speaker 2: both party kind of content to leave that behind having
[11:24] Speaker 2: done that just a few months ago.
[11:26] Speaker 1: Everything could change very quickly. But the impression I was
[11:30] Speaker 1: getting before the break was that neither party really wants
[11:34] Speaker 1: another government shut down. I get the sense that Democrats
[11:38] Speaker 1: felt like they held out as long as they could
[11:42] Speaker 1: to try to force action on this during the previous
[11:45] Speaker 1: government shutdown, and that doing that again would kind of
[11:50] Speaker 1: be fruitless. The deadline is also occurring after open enrollment
[11:55] Speaker 1: has already closed. I don't expect this to play a
[11:59] Speaker 1: huge role in the next set of negotiations to fund
[12:02] Speaker 1: the government.
[12:04] Speaker 2: Farther off, but not many months farther off. It is
[12:07] Speaker 2: the midterm election. Here we are in twenty twenty six
[12:09] Speaker 2: of interim election year. How is that coloring this debate
[12:12] Speaker 2: as we get closer to that.
[12:14] Speaker 1: I think Democrats are very eager to run on this issue.
[12:17] Speaker 1: I expect we will continue to hear a lot more
[12:20] Speaker 1: about this, but really plays well into the affordability pitch
[12:24] Speaker 1: they're making to voters, and felt was very successful and
[12:28] Speaker 1: off your elections in November. So this is something that
[12:31] Speaker 1: we expect to keep hearing about even if they don't
[12:35] Speaker 1: settle on a solution.
[12:37] Speaker 2: Meanwhile, people like Carrie van Mevrin are preparing for the
[12:40] Speaker 2: worst case scenario.
[12:42] Speaker 3: I know dozens of other small business owners as well
[12:45] Speaker 3: as families who some are just going to cross their
[12:50] Speaker 3: fingers and hope that they can get through until there's
[12:53] Speaker 3: better changes.
[12:54] Speaker 2: Carrie is already thinking about the difficult choices she may
[12:57] Speaker 2: have to make if she notices signs of another blood clot.
[13:00] Speaker 2: She says she'd have to think carefully before going to
[13:03] Speaker 2: the hospital. With her new ACA plan, next time I have.
[13:05] Speaker 3: The symptoms, do I take a chance and hope that
[13:08] Speaker 3: it's not or do I go to the hospital and
[13:11] Speaker 3: deal with the consequences financially and that you know, I
[13:14] Speaker 3: could lose my.
[13:14] Speaker 2: Home This is the Big Take from Bloomberg News. I'm
[13:23] Speaker 2: David gurat. To get more from The Big Take and
[13:25] Speaker 2: unlimited access to all of Bloomberg dot com, subscribe today
[13:28] Speaker 2: at bloomberg dot com slash podcast offer. If you like
[13:32] Speaker 2: this episode, make sure to follow and review The Big
[13:34] Speaker 2: Take wherever you listen to podcasts. It helps people find
[13:37] Speaker 2: the show. Thanks for listening. We'll be back tomorrow

Shows are listed from Apple Podcasts' charts and directory, and Podcast Index where it is used. Every show and episode belongs to its publisher and plays from the publisher's own feed; this site hosts none of them.