Sen. Tim Kaine said bipartisan negotiations are underway to revive Affordable Care Act subsidies that expired at the end of last year.
He said at a roundtable in Hampton Wednesday a small bipartisan group of senators is negotiating a possible extension of the enhanced subsidies, which were first expanded during the COVID-19 pandemic and lowered monthly premiums for hundreds of thousands of Virginians who buy coverage through the ACA marketplace.
The Republican-controlled House of Representatives already passed legislation earlier this month seeking to restore the subsidies, with a handful of Republicans joining with Democrats.
Senate Republicans, Kaine said, are seeking policy changes in exchange for their support of an extension. Those would include requiring enrollees receiving the enhanced subsidies to pay a small minimum monthly premium and limiting eligibility for the enhanced credits to people below certain income thresholds.
The income cap for enhanced subsidies will increase to 700% of the federal poverty level, up from the previous limit of 400%, meaning individuals now earning roughly $109,000 a year — or more than $225,000 for a family of four — would no longer qualify for the enhanced premiums.
“If we could do something like this in the Senate, I think it would pass in the House,” Kaine said. “If they would pass a straight three-year extension with the Republican majority, they would also pass an extension with some reforms that were reasonable.”
With no extension in place, people who purchased insurance through the ACA marketplace began paying higher premiums for 2026 coverage earlier this month.
Insurers announced average benchmark premiums are rising about 26% nationwide and the amount enrollees pay without enhanced tax credits is projected to more than double compared with 2025. Recent estimates from KFF, a nonpartisan health research organization, shows they’ll increase from roughly $888 to about $1,904 annually.
Kaine warned that the higher premiums are arriving as Congress is also weighing significant Medicaid cuts, which he said could further strain patients and providers, particularly in rural and lower-income communities.
He said hospitals and clinics are already factoring the expected reductions into their budgets, even though most of the cuts would not fully take effect until 2027 and 2028.
“Medicaid is what provides services for a child with a disability to be able to thrive enough to be able to go to school; Medicaid is what provides services to our parents and grandparents in nursing homes or to folks with disabilities, the services that folks need if they're dealing with severe mental health issues or substance use if Medicaid is cut,” Kaine said. “When those services go away, it's bad for quality of life, and it's bad for our community.”
Angela Futrell, the chief executive officer at Southeastern Virginia Health System, said during the roundtable Medicaid cuts could significantly strain safety-net providers, noting that around 35% of the health system’s patients are covered by Medicaid and roughly 26% are uninsured.
“We have to have a healthy balance of those who are uninsured, those who are on Medicaid and those who are insured in other areas,” Futrell said. “If we’re forced to front money instead of receiving discounted rates up front, it throws off our entire budget and forces health centers to make hard decisions about what services and even which sites can stay open.”
Local health professionals also raised concerns beyond healthcare costs, including persistent nursing and faculty shortages, low wages for social workers and ongoing gaps in access to mental health care.
Iris Lundy, director of health equity at Sentara Healthcare, said existing funding structures make it difficult to build and sustain a health care workforce.
“We need to see how we get more residents here and keep them, but we need more people that reflect our community,” Lundy said. “I think the way we have funding set up now it is excluding a whole population of people.”
Gov. Abigail Spanberger signed an executive order on lowering health care costs on her first day in office. Kaine said stronger federal action would make it easier for the governor to work with the legislature and secure state funding for healthcare.
“We’re not there yet,” Kaine said, adding that senators expect to review draft legislative language on extending the ACA subsidies when they return to Washington next week. “But we’re not giving up. We really need to do this for families.”
