Negotiations on APTCs hit speed bump. The passage of a clean three-year enhanced APTC extension in the House last week provided additional momentum to ongoing bipartisan Senate negotiations, given that a clean extension already failed in the Senate. Sen. Moreno (R-OH), who is leading the negotiation efforts, previously stated that the negotiated bill would be released on January 14, 2026, but, due to ongoing uncertainty and continued debate on key provisions, the bill release was delayed, and it is unclear if or when an agreement will be reached.
The holdup largely centers on abortion coverage. Conservatives are advocating for the agreement to prohibit any federally subsidized insurance plan from covering abortion services, known as the Hyde amendment. Democrats strongly oppose that policy, and President Trump last week urged Republicans to be flexible on abortion, although that message was largely not well received by Republicans in Congress. The APTC legislation could also include a requirement that beneficiaries pay a minimum premium and additional policies on health savings accounts, as requested by Senate Majority Leader Thune (R-SD).
Later in the week, President Trump unveiled his “Great Healthcare Plan,” which calls on Congress to lower premiums by sending money directly to consumers instead of through insurers, fund cost-sharing reductions, and enact other healthcare policies such as codifying most-favored-nation deals and enacting price transparency. The one-page plan is a high-level outline, and it remains to be seen whether and to what extent the president’s plan will factor into, or further stall, the Senate’s APTC negotiations.
Various other factors complicate efforts to smoothly extend the APTCs as time goes on. Open enrollment ended this week, so any APTC fix would have to be retroactive and might involve a new open enrollment period. Congress is simultaneously debating government funding (more below), which is the top priority for lawmakers this month. With the Senate out of session next week, negotiations could also lose momentum.
In related Affordable Care Act news, CMS released a fact sheet on 2026 open enrollment indicating that 22.8 million individuals signed up for the individual market for 2026 coverage, including 2.8 million new enrollees. In comparison, 23.6 million individuals signed up for coverage for 2025.
Lawmakers push FY 2026 funding packages forward. Government funding for many federal agencies and the health extenders will expire January 30, 2026. The House and Senate both continued to advance non-health-focused appropriations packages this week. A three-bill package (Interior-Environment, Energy-Water, and Commerce-Justice-Science) is headed to the president’s desk following Senate passage, and the House sent a two-bill package (Financial Services and State-Foreign Operations) to the Senate. The remaining appropriations bills – Defense, Labor-Health and Human Services (HHS), Transportation-Housing and Urban Development, and, possibly, Homeland Security – will comprise the final package to be considered, and an agreement may be unveiled as early as this weekend, although sticking points remain as of this writing, particularly with the Homeland Security bill, which may not be included.
Appropriators on both sides of the aisle are hoping to avoid another stopgap continuing resolution and instead pass full FY 2026 appropriations bills for all agencies in advance of the January 30, 2026, deadline, although the calendar is tight. The Senate is scheduled to be in recess the week of January 19, 2026, and the House has a recess scheduled for the final week of the month, although it could be shortened or cancelled.
House Oversight Committee discusses how to detect and prevent federal fraud. While Committee Chair Comer (R-KY) discussed fraud in Minnesota, including in the Medicaid program, where federal funding has been paused for certain services, Subcommittee Ranking Member Mfume (D-MD) noted that social service funds have also been frozen in New York, California, Colorado, and Illinois. He emphasized that fraud detection should be a bipartisan effort without partisan attacks on certain states. Democrats also noted that effectively addressing fraud would allow funds to be allocated to initiatives that truly serve those in need and would ease debates around APTCs. Suggestions from witnesses for how to prevent fraud included expanding the US Department of the Treasury’s Do Not Pay system and integrating artificial intelligence into agency fraud prevention workflows.
Senate HELP Committee debates abortion medications. During the hearing, Democrats emphasized that clinical evidence supports the safety and effectiveness of medication abortion drugs when used as directed. Republicans pressed the US Food and Drug Administration to reinstate stricter safety rules, including face-to-face care to ensure early detection of conditions such as ectopic pregnancy and to prevent coercion. Witnesses largely spoke about the importance of individualized clinical care and informed consent.
CMS issues RFI on Medicare claims system. The request for information (RFI) seeks information on large-scale claims processing and adjudication vendors in order to improve beneficiary experience, reduce provider burden, and improve administrative efficiency in traditional Medicare. CMS also released a draft request for proposals to allow potential vendors to review the requirements and provide feedback in their RFI response. Responses must be submitted here by February 7, 2026.
Next week is a short week with the Martin Luther King Jr. Day holiday on Monday. The Senate is scheduled to be out of session, but the House has a packed schedule. Scheduled hearings include a House Budget Committee hearing on healthcare costs and back-to-back House Energy and Commerce and House Ways and Means Committee hearings with insurance executives. The House Judiciary Committee will also continue congressional discussion on federal fraud in Minnesota. Conversations around APTCs and government funding may continue next week, including potential movement on FY 2026 appropriations bills.
