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A pair of dueling health care proposals put forth by Republicans and Democrats failed to advance in the Senate on Thursday.

The GOP-backed measure failed in a 51-48 vote. No Democrats voted in favor of the bill. Sen. Rand Paul (R-Ky.) was the only Republican to vote no.

The Republican proposal would have allowed Affordable Health Care (ACA) tax credits to expire and fund health savings accounts.

The Senate also voted on a version drafted by Democrats, which would have extended the ACA funds for three years and prevent premium hikes.

The Democrat-backed proposal failed to pass in a 51-48 vote. Four Republicans voted in favor of the Democratic measure.

The two votes come as COVID-era subsidies are set to expire at the end of the year. The failure of both health care proposals likely means that millions of Americans will face higher premiums in the new year unless a last-minute deal is struck.

The expiration of ACA subsidies was a point of contention during the federal government shutdown. In exchange for reopening the government,  Republicans agreed to hold a formal Senate vote by mid-December on a Democratic proposal to extend ACA subsidies.

But hopes for solving the health care issue faded in Washington after the Senate rejected the measure from both parties.

More than <a href="https://apnews.com/article/health-care-subsidies-congress-shutdown-democrats-republicans-bb3464820a347fd2c0399e78e335881e">24 million people</a> currently have health insurance through the ACA, also known as Obamacare.

ACA enrollees who make less than 400 percent of the federal poverty level qualify for permanent subsidies in the program that help them offset premium costs.

During the COVID-19 pandemic in 2021, Democrats added additional subsidies known as enhanced premium tax credits. Those subsidies, which apply to enrollees regardless of their income, are the ones set to expire Jan. 1.

Under the expansion, some lower-income enrollees received health care with no premiums while high earners paid no more than 8.5 percent of their income. Eligibility for middle-class income earners also expanded.

The political stakes of rising premiums come as affordability has emerged as a key issue for voters going into the midterm elections next year.

House Speaker Mike Johnson (R-La.) <a href="https://x.com/SpeakerJohnson/status/1999132374387363974?s=20">weighed</a> in on the issue.

“Let’s be clear: Democrats’ ‘affordability’ agenda is nothing more than wanting to give MASSIVE handouts to big insurance companies,” Johnson said. “They broke the health care system and now want taxpayers to subsidize it indefinitely — with NO reforms, NO accountability, and subsidies that even go to households making hundreds of thousands a year. This doesn’t lower costs. It hides the cost of their FAILED law.”

Meanwhile, Sen. Chuck Schumer (D-N.Y.) <a href="https://x.com/SenSchumer/status/1999170605728366876?s=20">said</a> Republicans chose to “rip away health care funding” and “kick millions off insurance” in order to give their “billionaire buddies a tax break.”

Schumer asserted that affording health care for many Americans is “the difference between life and death. “

About 28 percent of participants say they had problems paying for health care, up slightly from 23 percent in May 2025, according to a poll released on Thursday by health policy organization KFF.

<em>The Associated Press contributed to this report. </em>

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