’Tis the season of medical deadlines, this year more than ever.
Well before their neighbors put up their Halloween decorations, millions of older Americans were getting waves of unsolicited calls imploring them to change their coverage during the Medicare Advantage annual enrollment period from Oct. 15 to Dec. 7. This crescendo of junk calls punctuated by long television ads reached its peak over the past week or so.
This is also the deadline period for the 24 million Americans applying for medical coverage under the Affordable Care Act in 2026. Dates differ a little from state to state. In Georgia, you have until Dec. 15 to enroll in an ACA plan that begins Jan. 2026. After that, you have until Jan. 15, 2026, the so-called “late” deadline, to enroll in plans beginning Feb. 1, 2026.
This year, a more ominous deadline clock is ticking. Unless Congress can come to some kind of consensus on healthcare by next Monday, the ACA subsidies, which have enabled lower-income Americans to afford these plans, are due to expire at the end of the year.
Insurance company lobbyists have already gamed out the ways in which push might not come quite to shove until mid-January. But we have arrived at the accumulated result of decades of procrastination. Congressional Republicans, staring down the barrel at an election where affordability is the buzzword, can stand by their votes on the Big, Beautiful Bill and let the subsidies expire, or let the subsidies continue for a while longer — at least until after the 2026 elections.
The Senate is set to vote this week on a Democratic proposal for a three-year extension. Meanwhile, House Speaker Mike Johnson plans to unveil within days what many years have failed to produce: a Republican health care plan.
Of all the things Rep. Marjorie Taylor Greene said during her very public breakup with President Donald Trump and Republican House leadership, the denunciation of her party for getting to this point on healthcare probably had the broadest resonance. Regardless of what they think about tariffs or the Epstein files, millions of Americans are in exactly the place Greene finds herself, with grown children whose premiums are about to double.
If Johnson actually brings a Republican plan to a vote, it will pit the House leadership, armed with a gift bag of bright ideas from previous legislation that went nowhere and the determination to make a final break with the ACA, against endangered members much more willing to make an accommodation with Democrats.
Johnson is said to have told Trump in a phone call that the Republican leadership has no interest in prolonging the ACA subsidies, in which case we are set to see a decisive vote in the next few days that will have a lot to do with the future of the party. Given the party’s talent for delay and the brutal political realities of the moment, it’s hard to see that really happening.
A Pennsylvania Republican, Rep. Brian Fitzpatrick, has offered a bipartisan compromise, and more cracks in the wall are likely to turn up soon.
Meanwhile, what are the American people going to think about this? The longer the deadline clock keeps ticking, the worse the outcome next November is going to be for the GOP. Yet they are setting themselves up to vote on a plan that should have a long debate.
It would be ironic if the effort to end the ACA were to result in a leap beyond it, but there is enough chaos built into the current impasse to produce a variety of surprising results. Gallup announced last week that 57 percent of Americans, the highest yet reported, had a positive view of the ACA. Medicare for All is polling well also.
The Republican plan is said to have a big expansion of health savings accounts and new approaches to driving down the costs of drugs. There’s no question that U.S. healthcare policy could benefit from new ideas. The great frustration is that these ideas couldn’t have been debated earlier than the closing hours before the deadline.
As for the Democrats, they will be alert to every soundbite in coming days, eager to crank out those midterm ads. If they can rise to it, they might also have something to do with what comes next.
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