Republican lawmakers in both the House and Senate are breaking with their party and supporting measures to extend subsidies for health coverage under the Affordable Care Act (ACA) amid concerns over the tax credits’ nearing expiration—and the spike in premium costs it’s expected to cause.
Republican congressional leaders are seeking to keep the party united behind health care legislation that would allow the subsidies used by more than 20 million Americans to expire at the end of the year and instead seek to address the anticipated premium hikes by expanding health savings accounts. But with the deadline looming and worries about the party’s chances in the 2026 midterm elections mounting amid a string of Democratic victories across the country, a growing number of Republicans are defying leadership and joining Democrats’ efforts to bring an extension of the subsidies up for a vote.
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Four Republican Senators—Susan Collins of Maine, Lisa Murkowski and Dan Sullivan of Alaska, and Josh Hawley of Montana—on Thursday voted in favor of advancing a three-year extension of the subsidies, though the bill, which was introduced by Senate Minority Leader Chuck Schumer, failed to move forward as it fell below the 60-vote threshold.
“Families in Maine and across the country are struggling with the high cost of health insurance, and I want to prevent an unaffordable spike in health insurance premiums for many Americans who rely on these COVID-era subsidies,” Collins, who is up for re-election next year, said in a statement following her vote.
She and the three other GOP lawmakers who joined Democrats in supporting the measure also voted to advance a proposal by Republican Senators Bill Cassidy of Louisiana and Mike Crapo of Idaho that would have set up health savings accounts for Americans who purchase health insurance on the Affordable Care Act marketplace. That bill also failed to garner the necessary 60 votes.
Read more: What the End of Obamacare Subsidies Could Mean for Your Health Coverage
In the House, where Republican leadership was still preparing to release its health care package on Friday, a group of GOP lawmakers has backed attempts to force votes on bills that would extend the subsidies.
A dozen House Republicans have signed a discharge petition introduced on Wednesday by Rep. Brian Fitzpatrick, a Republican of Pennsylvania, that would bring a bill extending the tax credits for two years to the House floor. “Congress cannot sit idle while American families face a preventable crisis. Our job is to protect the people we serve, and that responsibility demands immediate action,” Fitzpatrick said in a statement. “This bill delivers the urgent help families need now, while giving Congress the runway to keep improving our healthcare system for the long term. Responsible governance means securing 80 percent of what families need today, rather than risking 100 percent of nothing tomorrow.”
As of Friday afternoon, the signatories included Republican Representatives Michael Lawler and Nick LaLota of New York, Robert P. Bresnahan and Ryan Mackenzie of Pennsylvania, Kevin Kiley and David Valadao of California, Don Bacon of Nebraska, Jefferson Van Drew of New Jersey, Jennifer Kiggans of Virginia, Marjorie Taylor Greene of Georgia, and Maria Elvira Salazar of Florida.
A similar petition introduced by Democratic Rep. Josh Gottheimer of New Jersey and Kiggans, which would force a vote on a bill including a one-year extension of the tax credits, has also been signed by the same Republican legislators, with the exception of Salazar.
Democrats have been pressing for an extension of the Affordable Care Act subsidies for months, making it a major demand during the record-long government shutdown. Eight Democratic Senators ultimately joined with Republicans in voting to reopen the government after Senate Majority Leader John Thune promised that a vote would be held in mid-December on an extension bill for the subsidies of Democrats’ choosing.
But with the expiration date now less than three weeks away, Democrats haven’t been able to secure a floor vote on an extension measure, and Congress has no clear solution in sight for the predicted rise in health insurance costs.
Both bills at the heart of the House discharge petitions introduced this week are long shots, and still far short of the support they would need to bring either bill to the floor using the tool. Discharge petitions require the backing of a simple majority of House members, or 218 signatories; in addition to the Republican defectors, twelve Democrats have so far signed Fitzpatrick’s petition, and 28 have signed Gottheimer and Kiggans’. Any bill passed by the House would still have to pass in the Senate, as well.
Some Republicans have warned that failing to prevent a spike in health care costs could hurt the party in next year’s elections. While the GOP made significant gains in the 2024 election, which gave it control of both chambers of Congress and the White House, Republicans are heading into 2026 with a slim—and shrinking—House majority as an increasing number of legislators are opting not to seek re-election, and the President’s party typically loses seats in the midterms. Sweeping Democratic victories this year in gubernatorial races in New Jersey and Virginia, smaller local elections in Georgia, and even in Miami, where voters this week elected their first Democratic mayor in 30 years, have only amplified Republicans’ concerns as they look toward next November.
Last year, the economy was cited as a top priority for voters. And affordability concerns have continued to mount this year, including among groups that helped put Trump back in the White House: A Politico poll released earlier this month found that nearly half of all Americans, including 37% of 2024 Trump voters, said that the cost of living in the country is the worst they can remember it being.
Those warning signs are hanging over the ongoing efforts to pass a health care measure. “If we fumble this health care ball, nothing else is going to matter,” Rep. John Rutherford of Florida told Politico. “If we don’t win the majority in the midterms, then none of this matters. We can’t do anything good then. I think everybody understands that.”
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