On December 11, 2025, the Senate failed to advance S.3385, a bill that would extend for three years the Affordable Care Act (ACA) enhanced premium tax credits, on a 51-48 vote.[1] The enhanced premium tax credits were created during the COVID-19 pandemic to lower the premiums that those who purchase health insurance on the ACA Marketplace pay each month. They expire at the end of the year, and absent Congressional action, many Americans will see their monthly premiums increase significantly, even doubling or more.[2] Proponents of the bill worry that without an extension, many low- to moderate-income enrollees may find themselves unable to afford health insurance.
Tribal health programs that operate a Tribal Sponsorship Program will also be affected by a failure to extend the enhanced premium tax credits. Tribal Sponsorship Programs allow Tribes to use their federal dollars to purchase healthcare coverage for their citizens through the Marketplace. This gives Tribal citizens portable coverage. It also allows Tribal health programs to increase their revenues. When patients have insurance, the Tribal hospital or clinic can bill that insurance for costs incurred when caring for the patient, rather than tapping into their very limited Indian Health Service (IHS) funds. Tribal health programs often find that the cost of purchasing insurance on the Health Insurance Marketplace is less than the amount they are able to bill, resulting in a net increase in revenues. This, in turn, allows Tribes to expand the services they are able to offer their citizens. The premium tax credits made available only through the Marketplace lower the cost of those premiums. The enhanced premium tax credits have made the Sponsorship Program even more affordable and easier to access. Tribal Sponsorship Programs will remain advantageous for Tribes even in the absence of a failure to extend the enhanced tax credits; however extending the tax credits would make those programs more affordable for Tribes.
Efforts to extend the enhanced premium tax credits have stalled in Congress, as seen by the failed vote in the Senate, but action may still be forthcoming. A bipartisan group of Senators is still working to negotiate an extension that will reach the sixty-vote threshold to advance in that chamber. This will likely consist of a short-term extension of one to two years, along with an income cap and other reforms to combat fraud and abuse.[3] A bipartisan group in the House is working to schedule a floor vote on a similar short-term extension through a discharge petition.[4]
Congress will need to pass something by the end of next week to avert the imminent steep rise in insurance premiums that consumers will face in January. Despite the work of many lawmakers, an extension is not guaranteed. Please let us know if you would like our assistance in reaching out to your members of Congress, urging them to support the extension of the enhanced premium tax credits.
[1] In the Senate, legislation needs 60 votes to overcome the filibuster. This bill, while favored by a majority of Senators, failed to clear that threshold.
[2] Justin Lo, Jared Ortaliza, Matt McGough, Emma Wager, and Cynthia Cox, “Premium Payments if Enhanced Premium Tax Credits Expire,” KFF, September 19, 2025, https://www.kff.org/affordable-care-act/premium-payments-if-enhanced-premium-tax-credits-expire/.
[3] The bill that the Senate most recently voted on, S.3385, did not include any income caps or other reforms.
[4] A discharge petition in the House allows a majority of members to force a bill onto the floor for a vote, bypassing stalled or blocked committee action, or opposition from House leadership.
