Republicans on Capitol Hill are quietly exploring potential compromises to extend federal subsidies for the Affordable Care Act (ACA), as the government shutdown enters its third week. While leaders like Speaker Mike Johnson and Senate Majority Leader John Thune have reiterated that negotiations on the subsidies must occur after the shutdown ends, internal discussions among House Republicans and Trump administration officials are beginning to take shape. These talks aim to create a framework for a potential deal that could prevent the tax credits from expiring at the end of the year, which would leave millions of Americans without health insurance as premiums potentially rise.
Behind the scenes, House Republican leaders are engaging in informal conversations with officials from the White House Office of Legislative Affairs and the Domestic Policy Council. One of these ongoing discussions involves the possibility of imposing minimum out-of-pocket premium payments for ACA enrollees. This idea has been raised among House GOP leadership as a way to ensure individuals are more financially responsible but could also reduce the risk of “phantom enrollees” — those who receive full subsidies without knowing or using the coverage.
Conservative lawmakers are also considering new income limits to restrict eligibility for the tax credits, which were expanded under the Biden administration. Previous income caps limited subsidies to individuals earning below four times the poverty line. Now, GOP negotiators are open to re-imposing these caps, with some Republicans, including Reps. Jen Kiggans and Brian Fitzpatrick, publicly pushing for bipartisan legislation to extend the subsidies for a year. Democratic officials, such as Senate Appropriations ranking member Patty Murray, have not outright dismissed this idea, noting that most beneficiaries already earn below $200,000.
Other proposals include grandfathering current enrollees to continue receiving the enhanced subsidies, along with stricter guardrails to combat waste and fraud in the health insurance system. However, the timing of this policy shift has raised concerns, as economic conditions are worsening and many Americans are losing Medicaid coverage due to new work requirements enacted through a GOP megabill. Some experts warn that imposing a grandfathering mechanism at this time could feel unfair to those struggling financially.
Meanwhile, the debate over abortion coverage remains a contentious issue, with pro-life groups arguing that the subsidies indirectly subsidize plans that include abortion services. However, Democratic leaders like Sen. Jeanne Shaheen and Sen. Ron Wyden have clearly stated that abortion restrictions are a non-negotiable issue and will not be part of any compromise on the broader subsidies debate.