As Congress nears a year-end deadline that threatens to let expanded Affordable Care Act health insurance subsidies expire, President Donald Trump has not formally endorsed a specific legislative pathway to prevent the expected sharp rise in premiums for millions of Americans.

The enhanced tax credits, originally expanded during the COVID-19 pandemic, are scheduled to end on December 31, a move that analysts warn could more than double average premiums for many marketplace enrollees unless action is taken.

Recent Senate leadership has acknowledged the difficult prospects for passing any measure before the deadline.

Rather than backing the Democratic proposal to extend the enhanced subsidies for several years, Mr. Trump and Republican leaders in Congress have coalesced around an alternative plan that would forgo subsidy extension in favour of one-time direct payments to individuals’ health savings accounts.

Under the Senate Republican bill championed by Senators Bill Cassidy and Mike Crapo, eligible enrollees would receive up to fifteen hundred dollars deposited into tax-advantaged accounts if paired with lower-cost insurance plans — an approach the president has publicly supported as a means of putting money directly in people’s hands and reducing insurer enrichment.

While the Republican alternative enjoys Mr. Trump’s endorsement, it does not maintain the existing enhanced tax credits that currently help roughly twenty-four million Americans afford their premiums.

Democratic leaders argue that without an extension of the current subsidies, premiums could increase dramatically in early 2026, creating financial pressure on households already struggling with rising health care costs.

Bipartisan efforts in the House seeking to force votes on extending the subsidies have so far failed to gain traction, and Senate leaders on both sides acknowledge that neither the Democratic nor Republican bills appear likely to secure the sixty votes needed to advance.

Mr. Trump’s office has previously circulated drafts of a broader health care proposal that might include a limited two-year extension of subsidies with new income caps and other changes.

However, White House officials stressed that no final plan has been formally announced, and the president himself rejected the notion of simply renewing the enhanced credits without other reforms.

His advisers have said he remains engaged in discussions but has yet to present a fully developed alternative that commands broad legislative support.

With Congress poised to adjourn for the holiday recess and no bipartisan compromise imminent, the expiration of premium tax credits looms as a significant policy challenge.

The administration’s preferred path — centred on direct support via health savings accounts — represents a sharp departure from maintaining the current subsidy framework, leaving uncertainty over how many Americans will be shielded from steep premium increases when the new year begins.