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The House on Thursday passed legislation to revive expired Affordable Care Act subsidies for three years, after a group of Republicans broke with party leaders and joined Democrats to force a vote that GOP leadership had tried to block.
The measure passed 230–196, with 17 Republicans joining all Democrats in approving the bill. Most of the GOP defectors represent competitive swing districts and have warned that rising health insurance costs could become a major liability ahead of the 2026 midterm elections.
The bill would restore enhanced premium tax credits for roughly 22 million Americans who buy insurance through the ACA marketplace. The subsidies expired Dec. 31 after Republicans blocked efforts last year to extend the funding, triggering projected premium increases averaging nearly 100% for affected enrollees this year.
According to the nonpartisan Congressional Budget Office, the legislation would cost $80 billion over three years, increase coverage by about 4 million people and reduce premiums for millions more.
The bill now heads to the Senate, where Republican leaders have declared it unlikely to advance.
Senate roadblocks ahead
While many GOP senators oppose reviving the ACA subsidies outright, some have signaled openness to a narrower extension with added restrictions. A bipartisan Senate working group is developing an alternative proposal, though it has yet to reach agreement on terms that could attract 60 votes.
Sen. Bernie Moreno, R-Ohio, said he is advocating a two-year extension that would cap eligibility at 700% of the federal poverty level and require all enrollees to pay at least $5 per month in premiums. Moreno also wants to allow enrollees to redirect tax credits into health savings accounts beginning in the second year — a provision Democrats have resisted.
Abortion policy remains the biggest unresolved issue. Moreno said he is still exploring ways to incorporate abortion restrictions sought by many Republicans, an issue that has stalled negotiations for months.
“We’re in the red zone,” Moreno said. “But that does not mean a touchdown. It could mean a 95-yard fumble.”
Senators briefed House members on the emerging framework during a bipartisan Problem Solvers Caucus meeting Thursday. The group hopes to release a compromise proposal next week, before the Senate recesses for Martin Luther King Jr. Day.
Other lawmakers are skeptical.
“I don’t see us getting to 60 votes on anything,” said Sen. Eric Schmitt, R-Mo., who urged Republicans to instead pursue a party-line approach through the budget reconciliation process.
Sen. Jeanne Shaheen, D-N.H., the lead Democratic negotiator, said talks are continuing but rejected Republican demands for new abortion language.
“There is no need to come to a compromise because it’s already been dealt with in the Affordable Care Act,” Shaheen said.
A rare House power play
The House vote followed an unusual procedural maneuver that stripped GOP leaders of control over the floor.
After Republicans declined to bring up the issue last year, House Minority Leader Hakeem Jeffries, D-N.Y., filed a discharge petition to force a vote. As the deadline approached, four moderate Republicans joined all 214 Democrats to reach the 218 signatures required to trigger floor action in the new year.
Jeffries celebrated the vote Thursday alongside Senate Minority Leader Chuck Schumer, D-N.Y., calling the bill a necessary step to prevent sharp increases in premiums, deductibles and copays.
“The affordability crisis is not a hoax. It is very real,” Jeffries said. “Health care costs are out of control.”
Schumer said extending the ACA subsidies is the fastest way to lower costs for Americans.
“It is the No. 1 thing to reduce costs immediately,” he said.
Last fall, Democrats withheld votes on a government funding bill in an effort to force action on the subsidies, leading to a record 43-day government shutdown before talks collapsed.
Whether the Senate can now produce a compromise remains uncertain — but the House vote has sharply raised the political pressure on Republicans to act.
