After a significant rebuke to House leadership, in which a bipartisan coalition in the House of Representatives voted 230-196 to pass legislation extending expired health care subsidies for millions of Americans, the contentious issue is set to return to the Senate.
The measure, which would provide a three-year extension of the tax credits, will not come into effect unless it is backed by a skeptical Senate where its future remains uncertain.
The bill’s passage was made possible after 17 Republicans joined nearly every Democrat to force the issue to the floor. This was achieved through a “discharge petition,” a rare procedural tactic used to bypass House Speaker Mike Johnson, who had blocked the bill for months.
Johnson and other GOP leaders argued against the extension, claiming the pandemic-era funding is “ripe with fraud” and primarily benefits a small percentage of the population. Rep. Jason Smith, chairman of the House Ways and Means Committee, argued the chamber should focus on lowering costs for all Americans rather than just the 7% who rely on ACA marketplace plans.
The vote came as a response to the expiration of enhanced tax credits on December 31, which has left approximately 22 to 24 million Americans facing a sharp rise in insurance costs. Without these subsidies, experts from KFF estimate that premiums for affected enrollees will increase by an average of 114%.
New York GOP Rep. Mike Lawler said he only backed the bill after Republican leaders declined to bring up a bipartisan two-year compromise bill he worked on last year.
“I am voting in favor of this discharge and of this legislation to send it to the Senate so that the Senate will have the opportunity to put forth a reform package that can pass Congress and become law,” Lawler said, calling on both parties to find solutions to the bigger, more structural issues.
“Enough of the blame game on both sides,” Lawler added. “Let’s focus on actually delivering affordable health care for Americans.”
The human impact of the lapsed credits is already being felt. In Louisiana, a mother in her final trimester of a high-risk pregnancy reported forgoing insurance altogether because she could no longer afford the premiums.Other families are reporting that monthly premiums have more than doubled, in some cases reaching $2,500 per month.
While the bill aims to keep an estimated 3-4 million people insured in the coming years, the nonpartisan Congressional Budget Office (CBO) warns it would increase the national deficit by approximately $80.6 billion.
Despite the House victory, the legislation faces an “uphill climb” in the Republican-led Senate. Senate Majority Leader John Thune has indicated that any successful plan must include income limits and require beneficiaries to pay at least a nominal amount for their coverage.
A pivotal figure in the upcoming debate is Sen. Bill Cassidy (R-La.), chairman of the Senate Health, Education, Labor, and Pensions Committee. Cassidy stated Sunday that any bipartisan deal must “conform” with the demands of Donald Trump.
Cassidy’s proposed reforms include Direct-to-Patient Funding which would shift subsidy dollars away from insurance companies—which he claims take 20% for profit and overhead—and send them directly to patients via expanded Health Savings Accounts (HSAs).
Cassidy also wants to see abortion coverage restrictions by changing ACA rules to ensure that every state offers plans that do not cover abortion.
President Donald Trump has encouraged Republicans to “take control” of the health care debate, an issue that previously stymied his administration.
“Health care, it’s never been our issue,” Trump said. “It should be our issue.” The President said his moves to reduce the cost of prescription drugs should be a vote winner but he also urged compromise on an issue that many GOP representatives hold dear.
Trump suggested that to get a deal, Republicans may need to rethink a long-standing provision that prevents federal dollars from being used to pay for abortions, known as the Hyde amendment.
“You have to be a little flexible on Hyde,” Trump said. “You know that. You gotta be a little flexible. You got to work something. You got to use ingenuity. You got to work.”
His comments met with criticism from many conservatives unwilling to compromise on federal funding being used for abortions.
Trump’s preferred approach to the ACA subsidies aligns with Cassidy’s, favoring direct payments to Americans for HSAs so they can manage their own insurance and bypass federal bureaucracy.
While Democrats largely reject the HSA-only model as insufficient for high medical costs, a small group of bipartisan senators is reportedly working on a compromise plan that could be unveiled this week.