Senate votes on Democratic health care bill after GOP plan fails

The Republican health care bill crafted by Sens. Mike Crapo and Bill Cassidy failed to advance in a 51 to 48 vote. The tally fell largely along party lines, with GOP Sen. Rand Paul joining Democrats to vote against advancing. Republican Sen. Steve Daines of Montana did not vote.

The procedural vote on the Democratic bill is up next. That is also expected to fail.

The Senate is now voting on the Republicans’ proposal to address health care costs, led by Sens. Bill Cassidy of Louisiana and Mike Crapo of Idaho. 

The bill is expected to fall short of the 60 votes needed to advance, and comes ahead of a long-anticipated vote on a Democratic bill that would extend enhanced tax credits under the ACA. That vote is also expected to fall short. 

Sen. Jeanne Shaheen, a New Hampshire Democrat who negotiated the deal with Republicans to end the shutdown, indicated openness to continued work to address health care on a bipartisan basis after today’s votes.

Speaking on the Senate floor following the majority leader, Shaheen said a lot of what Thune said about “costs and about addressing fraud and about lowering the cost of health care is something that we all ought to support.”

“I’m ready to come to the table and I think we would be better served if after we get through these votes, we sit down and come to a compromise to address the real costs that people are facing in terms of health care,” Shaheen said. “And I’m ready to do that.”

Shaheen said “there are members in both parties who want to find a responsible path forward.”
“I welcome the discussion on where we can find common ground,” she said. “But first we must keep millions of Americans from losing coverage in the coming months. Extending these credits is the easiest and most direct way to protect families.”

Addressing the chamber, Thune reiterated Republicans’ argument against a clean extension of the tax credits, saying the subsidies create “perverse incentives” that distort the insurance market and encourage fraud.

“Democrats’ so-called plan is a three-year extension of the status quo. No reforms, no revisions, no rethinking of the way that Obamacare works. Just a three-year extension of the status quo,” Thune said.

The Republican leader said the Democratic plan would not “do anything to address the perverse incentives that push Americans out of the employer-sponsored health care system and onto taxpayer-subsidized plans.”

“It’s not going to do anything to address the perverse incentives that encourage insurance companies to enrich themselves at taxpayer expense, and do nothing to address the rampant waste, fraud and abuse in Obamacare. And most of all … it will do nothing to bring down health care costs. Nothing. Zero. Under Democrats’ plan, insurance premiums will continue to spiral,” he said.

“Democrats don’t have a health care plan. They want to extend the status quo,” Thune added.

Speaking on the Senate floor, Minority Leader Chuck Schumer blasted Republicans’ health care proposal, saying it would do little to address rising costs for consumers.

“Republicans have had so many differences amongst themselves that for a while it looked like they weren’t going to put up a bill at all. But after that became too embarrassing an option for Republicans, they used Scotch tape and glue to come up with this ridiculous proposal that can’t be taken seriously, and does nothing — nothing — to avoid the impending health care crisis,” he said. “Even calling this Republican bill a proposal is generous, because the Republican bill is little more than junk insurance. It is no real plan at all.”

He said that Republicans’ “big idea is to essentially hand people about $80 a month and wish them good luck. And even to qualify for that check — listen to how bad this is — Americans would be forced onto bare-bones bronze plans with sky-high deductibles.”

Schumer said there is “only one option left to avoid falling over this health care cliff that Republicans have brought us to: a clean, simple, direct extension of the current ACA credits. Every single Democrat is unified behind this proposal. I urge Republicans to drop their divisions and join us.”

The Senate gaveled into session at 9:30 a.m. ahead of the procedural votes on the competing health care bills later in the morning. 

Majority Whip John Barrasso’s office said the chamber will proceed to the votes at 11:30 a.m., starting with the GOP bill and followed by the Democratic legislation. Both votes will technically be on invoking cloture on motions to proceed to the legislation and will require 60 votes to succeed.

The long-anticipated vote on the ACA tax credits comes in the aftermath of the shutdown, when Republicans agreed to allow a vote on a Democratic bill in exchange for reopening the government. The subsidies, which helped around 22 million low and middle-income Americans pay for health care costs in 2025, are set to expire at the end of the year. Annual premiums for those who purchase coverage through ACA exchanges are expected to more than double without an extension, according to KFF, stretching the already-strained budgets of millions.

Given the option to put forward a bill of their choosing, Democrats chose to bring up a clean three-year extension of the subsidies, a bill known as the Lower Health Care Costs Act. The move all but guaranteed that the effort would fail, since Republicans generally oppose an extension without significant reforms to address fraud and impose income caps. But Democrats are more than willing to force their GOP colleagues to vote against extending the subsidies, viewing the coming price hikes as a salient political issue heading into next year’s midterm elections.

Senate Minority Leader Chuck Schumer called Thursday’s vote on the tax credits extension a “moment of truth for Republicans,” noting that the credits are set to expire in a matter of weeks. 

“Congress should have solved this problem months ago,” Schumer said at a news conference Wednesday. “Hakeem Jeffries and I asked the Republican leadership and Donald Trump over and over and over again to sit down and come up with a solution to the crisis. They refused.”

Republicans have argued that the current structure of the tax credits, which involves sending the funds directly to insurance companies, encourages fraud, since brokers and agents are incentivized to enroll customers who may not qualify. GOP lawmakers have pointed to a recent report from the Government Accountability Office, in which investigators submitted applications for coverage through exchanges using fictitious personal details, most of which were still approved.

Republicans have sought to overhaul what they see as a broken health care system for years, but have failed to coalesce behind a strategy to implement significant changes.

After weeks of discussion, Senate Republicans announced this week that they would put forward a bill of their own for a side-by-side vote, hoping to alleviate the political pressure that would come with voting against the Democratic proposal.

The Republican bill, named the Health Care Freedom for Patients Act and led by Sens. Mike Crapo and Bill Cassidy, takes another approach to address health care costs. Rather than extending the enhanced tax credits, it would redirect funds to health savings accounts for those who use bronze plans on state exchanges. Proponents argue that doing so would allow people to save on premiums by switching to the lower-tier plans, while they would also be able to use the HSA funds toward their deductibles.

Senate Majority Leader John Thune announced Tuesday that Republicans would put up the Crapo-Cassidy bill, which he said “reflects the views of the Republicans here in the United States Senate.”

Democrats have largely rejected the Republican plan since it doesn’t address the tax credits, leaving millions with higher premiums in the short term.

On the Senate floor on Wednesday, Senate Majority Leader John Thune called the Democratic approach a “partisan messaging exercise,” saying they “seem hard-over on doing this.”

“I don’t have any expectation probably that we’re going to get Democrat votes for our proposal, but we are offering something that actually does reduce health care costs and premiums, puts power back in the hands of individuals, and that really is what this ought to be about,” Thune said.

As both sides appeared aware of the likelihood that the bills would fall short in Thursday’s votes, Thune didn’t rule out an extension of the tax credits going forward. 

“There is an interest in solving it,” Thune told reporters Wednesday. “Obviously we don’t have a lot of time to do this, but I think there are ways in which you could, where there’s a will, and if there are two sides willing to come together.”