LEILA FADEL, BYLINE: The enhanced Affordable Care Act subsidies have expired. On the first day of 2026, that is a fact. But there's still a little hope for people relying on these health care tax credits since a retroactive extension could be passed this year. Joining us to talk about this is Senator Peter Welch, a Democrat representing Vermont. He has been pushing to extend these health care tax credits. Welcome to the program, Senator Welch.
PETER WELCH: Thank you.
FADEL: We've reported pretty consistently that insurance premiums are expected to increase significantly. What other consequences can Americans expect from these subsidies ending?
WELCH: Well, the most significant is anybody - a small business, a farmer - whether they're in a Republican or a Democratic district, is going to get hammered. So a farmer in Vermont, their premium is going to go from 900 a month to $3,200 a month. So they're going to really face sticker shock. There's going to be a secondary impact because the hospitals, particularly in rural areas, are going to lose revenue because folks are going to show up to get care and not have any way to pay for it. So there'll be a ripple effect here, both immediate on the families who have to make a tough call - do they try to scrape together the money that they don't have? - and then on the institutions in our rural communities that are so important to us.
FADEL: Now, Vermont seems to be one of the states that will see the highest premium increases. What are your constituents saying to you?
WELCH: They're really terrified. I mean, the affordability issues that every American is facing - with rising utility bills, health care bills are a big part of it, groceries - this is really one where, in addition to the expense, it imposes an immense amount of insecurity. You know, a mother that I was talking to, with two kids, said she doesn't know what to do. She feels totally irresponsible not to have health care, but it's totally impossible for her to afford it. So I think this is really tough. And frankly, it's not whether you're politically oriented towards Trump or the Democrats. It's really everybody trying to take care of their families. So this is really a bipartisan catastrophe in the making.
FADEL: Now, speaking of that, it was reported a few days ago that a bipartisan group of senators met by phone to discuss health care negotiations. Were you part of that call?
WELCH: Yes, I was. And there's a determination on both sides of the aisle to do every single thing we can to avoid this catastrophe. And there's some practical things we could do to make that happen. You know, we could extend the credits for a couple of years. We could reform it. You could put an income cap. You could have a copay. You could have penalties on insurers who commit fraud, or insurance agents. And you actually could introduce some cost-saving reductions that have bipartisan support, and if we were successful in that, it actually could bring down health care premiums by about 11%. So there's common ground here to do something that's beneficial to all Americans, so we're determined to keep trying.
FADEL: And are you specifically pushing for this path we mentioned for this to change to get an extension of these subsidies passed retroactively?
WELCH: Well, we would. What we would do is extend the open enrollment period, and we'd have to give folks an opportunity to take a look and see, if we get the credits extended, does it make sense for them to be able to get back on health care? So it would be, in effect, retroactive, but this is something that could be done. It would require that President Trump play a major role in this because he has such influence over the Republican majority in the House and even in the Senate. But where I have some optimism is that there's a number of Republican and Democratic senators who are seeing what a disaster this will be for families that they represent. That's the common ground here, and it's a doable thing. And the one thing that's totally unacceptable is that people who have no control over how these premiums have increased - and these are the families, the small businesses, the farmers - they should not be the ones that pay the price here.
FADEL: Now, do you think there is enough support from your colleagues who are willing to shift their position in upcoming negotiations and pass a retroactive extension for these subsidies?
WELCH: I do - in the Senate. I can speak for the Senate. But it really will require that President Trump weigh in. And one of the things that President Trump has indicated, according to my Republican colleagues, is that he wants to have some room in there for what's called an HSA, a health savings account. And one of the topics of discussion is whether we could give the insured, the person, an option to opt into that if they wish to. But we need President Trump, and I think he's the one who can make this happen.
FADEL: And what possible path is there to get President Trump to the table?
WELCH: Well, my Republican colleagues can be speaking to him, and some of them are. So that's really going to be the burden they bear. And my colleagues on the Republican side that are really intent on trying to get an extension are doing their best to engage with the president. But he'll be critical.
FADEL: Senator Peter Welch of Vermont, thank you for your time and Happy New Year.
WELCH: Leila, same to you. Thank you, and Happy New Year to America.
FADEL: Happy New Year. We also reached out to multiple Republican lawmakers, and those invitations remain open. Transcript provided by NPR, Copyright NPR.
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