High on the list of issues lawmakers from both parties want to address this summer is the affordability of health care and health insurance. Of course, Republicans and Democrats are not on the same page on the “how” to address these issues, which polling suggests are central to voter concerns. And voter concerns are at the top of lawmakers’ minds as they head towards the November mid-term elections.

Generally, Republicans want to address health care issue concerns by focusing on rooting out fraud in Medicare and Medicaid, and/or by shifting Affordable Care Act (ACA) insurance premium subsidies from insurers (who use them to lower the cost of health insurance premiums) to individuals, probably in the form of contributions to their health savings accounts (HSAs). Democrats, on the other hand, prefer measures to restore the enhanced premium subsidies that were in force during the COVID era, but which expired at the beginning of this year.

These issues are likely to arise in the context of government funding legislation, although there is an outside chance they will move on a different legislative vehicle or even on their own. But as of right now, there is no consensus on what proposals to pass outside of a GOP-only reconciliation bill—and not much consensus (and therefore chance) in a Republican-only bill. In fact, a Republican-only bill (a new reconciliation bill) is itself facing fairly dim prospects. Very narrow majorities (three in the Senate, currently two in the House) make GOP near-unanimity a must, and there is currently too much disagreement among House and Senate Republicans to support a bill that would have to be passed by virtually every Republican in Congress.

Prospects: All legislation—even the “must pass” government funding bills—is fraught with political difficulty. Disagreements made more difficult by failing trust among lawmakers even in the same party (and with the President) make the potential for compromise/agreement hard to predict. And with the November elections that will determine partisan control of Congress in 2027, the path to consensus gets even harder. It will be a long, hot summer—and a tough fall, too.

NAIFA Staff Contacts: Diane Boyle – Senior Vice President – Government Relations, at dboyle@naifa.org; Mike Hedge – Senior Director – Government Relations, at mhedge@naifa.org; or Jayne Fitzgerald – Director – Government Relations, at jfitzgerald@naifa.org