US Senate sinks twin health plans as insurance time bomb ticks

Without action in the next three weeks, insurance payments for more than 20 million low- and middle-income Americans are projected to more than double, raising the political stakes as Washington edges into a campaign season defined by cost-of-living pressures.

Democrats were promised a vote on a three-year extension of enhanced Affordable Care Act (ACA) subsidies as part of a deal that ended a record 43-day government shutdown last month. 

While Republican Majority Leader John Thune agreed to hold the vote, he had not promised its success, and Republicans were almost unified in opposition.

Under pressure from moderates and senators up for reelection, Thune had also agreed to bring forward a Republican alternative for a vote alongside the Democratic bill. 

This plan would have replaced subsidies with contributions to Health Savings Accounts to help cover out-of-pocket expenses. 

But reaching the 60-vote threshold in the 100-seat Senate always looked like a longshot, with only 53 Republicans making up the majority -- and Democrats duly blocked the bill.

The average payment is expected to rise by roughly 114 percent -- an extra $1,000 to $1,500 in annual premiums for a typical family, according to health policy research group KFF. 

- 'Life and death vote' -

Up to seven million ACA enrollees could lose their coverage altogether, statistical modeling indicates, and most are expected to become uninsured rather than switching to other plans. 

Thune, however, has signaled that Thursday's defeats might open the way for talks in 2026. 

"When we get through this exercise this week the question is, 'Are there enough Democrats who want to fix the problem?'" he told reporters on Wednesday, adding that he believed there was "a path forward."

"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."

Republicans say they are unwilling to back a clean extension but believe the broader issue of rising health costs can be addressed early next year, potentially as part of negotiations over government funding due to expire on January 30. 

They are hoping to use special Senate procedures to circumvent the 60-vote rule and go it alone, arguing that Democrats have little incentive to compromise in an election year -- a calculation the minority party denies.

In the House, the landscape is even more fractured. Multiple Republicans -- including the leadership -- unveiled a plethora of ideas aimed at lowering costs, though none includes extending ACA subsidies or looks to have sufficient backing.

With competing petitions, no unified House strategy and little sign of leadership buy-in, the chances of a bipartisan compromise emerging before year's end now appear extremely slim.

Senate Minority Leader Chuck Schumer gave an impassioned floor speech ahead of the vote on the Democratic bill, setting out what he saw as the stakes. 

"This is not a political fight. This is not a symbolic vote," he said. "This is a life and death vote, because people who will lose their health care could face that horrible, horrible end."

ft/msp/acb