Republican Under New GOP Pressure
Senate Majority Leader John Thune is facing increasing pressure from within his own party to bring health care reform legislation to the Senate floor, as Republican lawmakers warn that soaring costs could fuel voter backlash in November.
With insurance premiums climbing and affordability becoming a top concern for older Americans and middle-class families, conservatives argue that delaying action risks handing Democrats a powerful election issue.
Push to Use Budget Reconciliation Grows
Republican senators aligned with Donald Trump are urging leadership to advance a health care package modeled after the president’s latest reform proposal. They want the legislation moved through the budget reconciliation process, which would allow passage with a simple majority and bypass a Democratic filibuster.
Thune has so far resisted committing to reconciliation but has acknowledged it remains an option under Senate rules.
Moderate Republicans Warn of Premium Shock
At the same time, several moderate and swing-state Republicans are pushing for a vote to extend enhanced Affordable Care Act (ACA) subsidies that expired earlier this year. They warn that without action, millions of Americans could see sharp increases in monthly insurance premiums.
Those efforts, however, have stalled. Bipartisan talks aimed at extending or reforming the subsidies have largely collapsed, with lawmakers on both sides privately expressing skepticism that a deal can be reached.
Conservatives Demand Action, Not Talks
The stalled negotiations have strengthened the hand of Senate conservatives led by Rick Scott, who is calling for Republicans to move forward on their own.
Scott argues the Senate already has the tools needed to advance legislation, including forcing Democrats to actively hold the floor through extended debate rather than relying on automatic procedural roadblocks.
“We need to fix health care,” Scott said recently. “If Democrats want to oppose reform, they should have to explain that to voters.”
Rising Costs Fuel Urgency
Republicans say the pressure is coming from constituents who are struggling with higher premiums and out-of-pocket costs. According to projections from KFF, more than 22 million Americans who rely on ACA marketplace subsidies could see their average annual premiums more than double by 2026 if no reforms are enacted.
For many voters, especially retirees and fixed-income households, health care affordability is becoming as important as inflation and gas prices.
Trump-Backed Plan Focuses on Consumer Control
Scott’s proposal mirrors President Trump’s health care framework, which shifts away from expanded subsidies and instead emphasizes individual control through health savings accounts, referred to as “Trump Health Freedom Accounts.”
Rather than extending expired ACA tax credits, the plan would allow states to convert existing subsidies into direct contributions that families could use to shop for care.
Trump’s proposal also includes:
- New transparency requirements for insurers on denied claims
- A crackdown on pharmacy benefit managers blamed for rising drug prices
- Codifying “most-favored-nation” pricing to lower prescription drug costs
Republicans Warn of Midterm Consequences
Other GOP lawmakers, including John Kennedy, have warned that failing to act on health care could hurt Republicans in the 2026 midterms.
Kennedy has urged leadership to use reconciliation, arguing that fear of internal disagreement should not outweigh voter concerns.
“The cost of living is going to dominate the midterms,” Kennedy said. “Health care is a major part of that.”
Leadership Still Hesitant
Thune has not ruled out reconciliation but has emphasized that any effort would require strong engagement from the White House and a clearly defined goal. He has also pointed to House Republicans, who are considering their own reconciliation package later this year.
“You don’t just put a reconciliation bill on the floor,” Thune said recently. “There has to be a specific objective and strong presidential involvement.”
Bottom Line
As health care costs continue to rise, Republicans are facing a narrowing window to act. With voters increasingly focused on affordability, party leaders must decide whether to push forward with reform — or risk paying the political price for inaction.
