As a critical year-end deadline looms, Republicans are urgently trying to formulate a health care strategy to prevent a sharp increase in insurance premiums for millions of Americans. This frenzy comes amid a divided GOP and a lack of pressure from President Trump to finalize a deal.

Without a push from the President, Republican congressional leaders have proposed a collection of conservative health care initiatives. These proposals, however, do not include provisions to extend tax credits for Affordable Care Act (ACA) insurance plans. If these credits lapse, more than 20 million people could face significant cost hikes in 2026.

Given the political landscape, the GOP’s current plan is unlikely to pass in the Senate, where bipartisan support is essential. This situation has prompted some moderate Republicans to consider last-minute negotiations with Democrats to renew the ACA tax credits, aiming to prevent the potential financial burden that could negatively impact their prospects in the upcoming midterm elections.

Representatives Mike Lawler and Nick LaLota, both Republicans from New York, are part of a bipartisan group of moderates striving to initiate a House vote on extending these tax credits while seeking a long-term resolution.

However, staunch conservatives and pro-Trump Republicans remain firmly against any measures that would reinforce the insurance system outside traditional employer-based or government programs.

On the other side, Democratic leaders are advocating for a straightforward three-year extension of the subsidies. They have indicated a willingness to discuss a shorter extension or introduce income limits, but they remain skeptical about the Republicans’ commitment to reaching a deal that would need to clear both legislative chambers and receive the President’s approval.

Rep. Hakeem Jeffries and Sen. Chuck Schumer, both New York Democrats, accuse Republicans of failing to deal with the looming health crisis for months, even as they found time to pass Trump’s One Big Beautiful Bill, which included tax cuts for corporations and the wealthy and cuts to Medicaid for lower-income people.

Republicans, who control both houses of Congress and the White House, counter by claiming Democrats are more interested in scoring political points than reaching a bipartisan solution.

If no health deal is reached, more than 20 million Americans will be hit with dramatically higher health insurance premiums in the new year. Polls say voters already give Trump and Republicans failing marks when it comes to dealing with health care, the economy and higher prices.

That could spell doom for Republicans as they try to hold onto control of Congress in the 2026 midterms with Democrats hoping that a blue wave can catapult them back into control of the House and maybe even the Senate.