House passes bill extending ACA subsidies in rebuke to GOP leaders

House votes to extend ACA subsidies as GOP leaders face a setback

The U.S. House passed legislation Thursday to extend health care subsidies for people who get coverage through the Affordable Care Act, after the enhanced tax credits expired late last year. The bill won approval 230-196, with 17 Republican lawmakers joining every Democrat to support the measure.

Nonpartisan Congressional Budget Office estimates that the proposal—which would provide a three-year extension of the subsidy—would increase the nation’s deficit by about $80.6 billion over the decade. The CBO also estimated the bill would increase the number of people with health insurance by 100,000 this year, 3 million in 2027, 4 million in 2028 and 1.1 million in 2029.

Vote forced through discharge petition

The House vote came after a handful of Republicans signed a discharge petition to unlock debate and bypass objections from House Speaker Mike Johnson. The measure now heads to the Senate, where pressure is building for a bipartisan compromise.

Jeffries, the House Democratic leader, said the vote reflected urgency over rising premium costs for Americans enrolled in ACA plans. “The affordability crisis is not a ‘hoax,’ it is very real — despite what Donald Trump has had to say,” Jeffries said, adding that Democrats had signaled before last year’s government shutdown that they would continue the fight “until we win this affordability fight.” He said the House had an opportunity to “take a meaningful step forward.”

Johnson and Republicans urge a no vote

Johnson’s office argued Thursday that federal health care funding from the COVID-19 era was rife with fraud and urged lawmakers to vote no. On the floor, Republicans also argued the chamber should focus on lowering insurance costs for the broader population rather than only for people enrolled in marketplace plans.

Rep. Jason Smith, the Republican chairman of the House Ways and Means Committee, said, “Only 7% of the population relies on Obamacare marketplace plans,” and that the chamber should be about “helping 100% of Americans.”

Senate talks on an alternative plan

The House approval comes as Senate leaders and a small group of senators from both parties work on an alternative approach. Senate Majority Leader John Thune said a plan that finds support in his chamber would need income limits, and that beneficiaries would have to pay at least a nominal amount for their coverage.

Thune also said the Senate’s discussions would require expansion of health savings accounts, which allow people to save money and withdraw it tax-free as long as it is spent on qualified medical expenses.

GOP Sen. Bernie Moreno of Ohio, part of the group of roughly a dozen senators, said he and other lawmakers hope to deliver a framework next week and that they met with House colleagues on options.

Sen. Jeanne Shaheen, a Democrat involved in the negotiations, said there is agreement on addressing fraud in health care. Shaheen said lawmakers recognize that “we have millions of people in this country who are going to lose — are losing, have lost — their health insurance because they can’t afford the premiums,” and she said negotiations were aimed at reaching agreement that would help “and the sooner we can do that, the better.”

Fight over structure: tax credits vs. direct-to-consumer funding

The negotiations are playing out amid competing approaches to how aid should be delivered. Trump has pushed Republicans to send money directly to Americans for health savings accounts to bypass the federal government and handle insurance on their own, while Democrats largely reject that approach as insufficient for covering high health care costs.

Republicans force the House to vote

The decision by Republicans to join Democrats for the discharge petition was described as an affront to Johnson’s leadership team, which lost control of what reached the House floor after rank-and-file lawmakers joined the workaround.

Republican Reps. Brian Fitzpatrick, Robert Bresnahan and Ryan Mackenzie, all from Pennsylvania, and Mike Lawler of New York signed the discharge petition, pushing it to the number of 218 needed to force a House vote.

After the vote, Jeffries said Thune should bring the Democratic bill to the Senate floor for an immediate vote.