The fate of the enhanced premium tax credits (EPTCs) for Affordable Care Act (ACA) Marketplace plans is front and center on Capitol Hill this month. On December 11, the Senate failed to advance a bill that would provide a clean three-year extension of the EPTCs, which are set to expire on December 31, 2025. The Democratic proposal was widely expected to fall short of the 60-vote threshold, and only garnered support from four Republican Senators. 

The same day, the Senate rejected a Republican counterproposal, the Health Care Freedom for Patients Act, led by Senators Bill Cassidy (R-LA) and Mike Crapo (R-ID), the Chairs of the Senate Committees on Health, Education, Labor, and Pensions (HELP) and Finance, respectively. The Republican proposal did not include an extension of EPTCs, but rather would provide up to $1,500 over the next two years through health savings accounts (HSAs) for certain individuals enrolled in select ACA Marketplace plans, while also funding cost-sharing reduction (CSR) payments.

On December 12, House Republicans released the Lower Health Care Premiums for All Americans Act, which includes alternative proposals to lower health care costs. Specifically, the legislation would appropriate CSR payments, require more transparency from pharmacy benefit managers (PBMs), clarify stop-loss insurance, expand Association Health Plans, and codify Custom Health Option and Individual Choice Expense (CHOICE) Arrangements. Speaker Johnson intends for the House to vote on the Republican health care package this week. 

Representative Brian Fitzpatrick (R-PA) also has filed a discharge petition to force a floor vote on a bill that would extend EPTCs through 2027 with income caps and other anti-fraud reforms. The bipartisan legislation also includes provisions to expand access to HSAs; simplify premium payments; and prohibit PBM spread pricing and require full rebate pass-through to plans. The discharge petition needs 218 signatures to trigger a floor vote next month. Separately, another discharge petition, led by Rep. Jen Kiggans (R-VA) and Josh Gottheimer (D-NJ), offers a limited one-year extension of EPTCs, among other provisions. House Democratic Leader Hakeem Jeffries (D-NY) is championing a discharge petition that provides for a clean three-year extension of the EPTCs. 

Earlier this week, a bipartisan group of more than 20 Senators met for nearly two hours, trying to find consensus on a short-term EPTC extension framework. A resolution has not yet materialized. Given the lack of consensus in the House and Senate, it is likely that both chambers will depart for the holiday break this week without passing a health care package or legislation that would address the expiration of the EPTCs at the end of the year.

Regarding fiscal year (FY) 2026 appropriations, House and Senate appropriators are both seeking to find a pathway to move some form of a minibus—with varying appropriations bills packaged together—but it seems highly unlikely that there will be movement before the end of the year.

Impact on General Dentistry: The expiration of EPTCs could affect patient access, affordability and coverage, thereby creating uncertainty and instability for providers and patients alike. Rising costs may lead individuals to forgo routine care, increasing reliance on emergency treatment and worsening oral health outcomes.