House Approves GOP Health Bill That Omits Extension of ACA Subsidies

The House of Representatives on Wednesday passed a Republican health care package that does not renew soon-to-expire Affordable Care Act subsidies, sending the measure to the Senate with a 216–211 vote. Lawmakers left for the holiday recess knowing millions of Americans face higher insurance premiums when the subsidies end on December 31.

All but one Republican supported the bill, with Rep. Thomas Massie casting the sole GOP “no” vote. Four moderate Republicans—Reps. Brian Fitzpatrick of Pennsylvania, Mike Lawler of New York, Rob Bresnahan of Pennsylvania and Ryan Mackenzie of Pennsylvania—joined the majority after briefly aligning with Democrats earlier in the day. Every Democrat present opposed the package, which has little chance of clearing the Democratic-controlled Senate.

Dispute Over Subsidies Spills Onto House Floor

Hours before the vote, the same four Republicans signed a discharge petition initiated by House Democratic Leader Hakeem Jeffries. The petition gathered the 218 signatures required to force consideration of a separate bill that would provide a three-year extension of the subsidies. Under House rules, however, that legislation cannot reach the floor before January 2026.

Speaker Mike Johnson, leading a chamber where Republicans hold one of the narrowest majorities in U.S. history, rejected suggestions that the revolt signaled a loss of control. “When you have a razor-thin margin, all the procedures in the book are on the table,” he told reporters. Johnson acknowledged ongoing internal discussions but offered no commitment to schedule a direct vote on the subsidy extension.

The immediate clash began Tuesday night when the Republican-led Rules Committee blocked amendments aimed at continuing the subsidies. The panel’s decision prompted moderates to join Democrats in pressing for a vote, arguing that constituents would suffer from steep premium increases if Congress failed to act.

Moderates Cite Constituent Impact

Rep. Lawler said he did not endorse the Democratic bill “as written” but felt compelled to sign the petition after leadership prevented any vote on the question. “My priority is ensuring Hudson Valley families aren’t caught in the gridlock,” he posted on X. Fitzpatrick called for an up-or-down vote, telling reporters, “You cannot keep bills off the floor because you’re afraid they’re going to pass.”

Bresnahan faulted leaders of both parties for failing to reach a compromise. “Doing nothing was not an option,” he said in a statement, noting that the GOP package was the only remaining vehicle before the recess. Mackenzie echoed the concern, citing potential cost increases for residents in his district.

Background on Expiring Assistance

The premium subsidies, originally expanded under pandemic-era legislation, lower monthly insurance costs for millions of marketplace enrollees. The assistance is set to lapse at the end of the year unless Congress intervenes. HealthCare.gov outlines eligibility rules and notes that the enhanced aid has significantly reduced out-of-pocket payments since 2021.

Democrats made the subsidies a central issue during a 43-day government funding standoff earlier this fall, but negotiations with Republicans failed to produce an agreement. Last week, the Senate rejected a clean three-year extension in separate votes, though several GOP senators crossed party lines to support it.

Imagem: Internet

Senate Outlook

Senators are not expected to take up the House-passed bill, which omits the subsidy language. Instead, Democratic leaders have signaled they will revisit the issue in January, possibly using the discharge petition process in the House as leverage. Any resolution would require bipartisan support, as Republicans can block legislation in the Senate without 60 votes.

In the meantime, insurers have warned that premiums could rise sharply when the calendar turns. Analysts project that some households could face increases of several hundred dollars per month, depending on income and location. Advocates for the extension say the higher costs could prompt many consumers to drop coverage altogether.

Procedural Next Steps

The discharge petition filed Wednesday cannot trigger floor action until early January at the earliest, because House rules impose a waiting period after the chamber adjourns for recess. Should the petition proceed, members would vote on a straight three-year extension of the subsidies without additional policy changes.

Whether that vote occurs may hinge on Speaker Johnson’s calculations. After the petition reached 218 signatures, Johnson was seen holding private discussions with the four moderates on the House floor. He later described the exchange as “intense fellowship” but insisted Republicans remain unified around broader health policy goals.

For now, observers are watching to see if the looming premium hikes intensify pressure on lawmakers during the holiday break. Constituents are scheduled to receive January invoices reflecting the loss of subsidies unless Congress reverses course. A divided Senate and a narrowly split House leave the timeline for relief uncertain.

As Capitol Hill adjourns, both chambers are expected to resume negotiations in early January, with the discharge petition, potential Senate amendments and mounting constituent feedback shaping the next round of debate.

Crédito da imagem: Aaron Schwartz/Reuters