More than a dozen House Republicans joined every Democrat on Thursday to pass a bill to extend enhanced Affordable Care Act subsidies for three years — the sharpest rejection by GOP members of the party’s leadership yet.
The pandemic-era subsidies expired at the end of last year, driving up costs for millions of Americans who buy health insurance on the ACA marketplace and qualified for the assistance. GOP leaders made no attempt to address the issue as the deadline neared, despite warnings from members in swing districts that higher prices could threaten their chances in this fall’s midterm elections. The party has been trying unsuccessfully to dismantle the ACA since it became law in 2010.
Prospects for passage in the Senate are unclear, though, as the chamber has already blocked attempts to extend the subsidies.
The lack of action in the House led four House Republicans to join Democrats in December to force a vote on legislation backed by Minority Leader Hakeem Jeffries (D-New York). The vote Thursday over the objections of House Republican leaders was the result of that maneuver. The bill passed by a 230-196 vote, with 17 Republicans supporting it.
For House Speaker Mike Johnson (R-Louisiana), the vote is the starkest example yet of the difficulty of leading an incredibly narrow House majority. Republicans can only lose two votes if all Democrats are present and voting, after the resignation of former congresswoman Marjorie Taylor Greene (R-Georgia) and the death of Rep. Doug LaMalfa (R-California).
The slim margin has emboldened Democrats in the minority and bipartisan-seeking Republicans to introduce legislation through a vehicle known as a discharge petition, which can force a vote on the House floor for any measure with the support of 218 lawmakers.
“Donald Trump promised to lower costs on day one of his presidency. Costs aren’t going down, they’ve gone up, and so it’s an all-hands-on-deck effort that Democrats are committed to make sure we lower the high cost of living,” Jeffries said Thursday.
What happens next on health care is up in the air. Senate Minority Leader Charles E. Schumer (D-New York) had called on Senate Majority Leader John Thune (R-South Dakota) to put the House bill on the Senate floor if it passed. But the Senate last month blocked a similar bill because not enough Republicans joined with Democrats to overcome a filibuster. Thune allowed that vote as part of an earlier deal with moderate Democrats who joined the GOP to end the longest government shutdown in history.
Enrollment in health insurance plans through Healthcare.gov has modestly declined, underscoring concerns that higher consumer costs after Congress failed to extend extra federal assistance would cause people to drop out. Around 15.6 million Americans had signed up on the Affordable Care Act federal marketplace as of Jan. 3, according to three people at the Centers for Medicare and Medicaid Services, who spoke on the condition of anonymity because they weren’t authorized to speak to the press. Enrollment totaled 16.7 million people at the same time last year.
Federal subsidies remain available to the vast majority of marketplace enrollees, but at lower levels than under the pandemic-era subsidies. Enrollment in Healthcare.gov and the state-run marketplaces doesn’t end until Jan. 15, and there is likely to be a surge in sign-ups ahead of the deadline. Analysts and the Congressional Budget Office have predicted sign-ups will decline from a high of 24 million in 2025, as most enrollees faced higher monthly payments without the extra boost from pandemic-era subsidies.
Most Republicans expressed their dismay that colleagues joined with Democrats to pass the bill in the lead-up to Thursday’s vote.
“It’s audacious to call it affordable health care,” said Rep. Jodey Arrington (R-Texas), who chairs the House Budget Committee. “No Republican should ever support this. They didn’t support Obamacare when it was designed, they shouldn’t support doubling down on the failed policy.”
President Donald Trump has not endorsed a straight extension of the health care subsidies, instead rallying House Republicans on Tuesday to craft new legislation that would reshuffle the health care industry.
“We’re going to reduce health care by a lot. One other thing on health care, it’s never been our issue. It should be our issue,” Trump said.
Trump loosely proposed sending money directly to citizens’ health care accounts rather than paying subsidies to insurance companies, which is how the pandemic-era program worked. But any such plan could cost billions of dollars, and fiscal conservatives would balk.
A bipartisan group of senators has been working on a compromise bill, but it’s unclear whether that can secure the 60 votes necessary to advance in the upper chamber.
Thune said Tuesday that any bill to extend the subsidies would need to include Republican priorities, including income limits, minimum out-of-pocket premiums, an expansion of health savings accounts and abortion restrictions. Democrats have opposed including any new abortion language, which has made it tough to negotiate a compromise because staunchly conservative lawmakers have demanded such provisions to even enter negotiations with other Republicans.
Trump told the House GOP on Tuesday that they should be “flexible” on abortion restrictions, a sign many moderate Republicans welcomed.
Bipartisan House lawmakers of the Problem Solvers Caucus met with senators Thursday to discuss the possibility of introducing identical legislation in both chambers in hopes of pressuring leaders for a vote.
Rep. Michael Lawler (R-New York) said he voted in favor of the measure Thursday in hopes that it pressures the Senate to “put forth a reform package that can pass Congress and become law.”
Sen. Bernie Moreno (R-Ohio) said the House bill would never pass the Senate but could serve as a shell for the legislation that he and a bipartisan group of senators are working on. The House bill “probably wouldn’t even be put on the floor, because why waste floor time on something that we’ve already considered?” Moreno said Wednesday. “But the fact that it gives us something to amend, then it’s very valuable.”
The framework the bipartisan group is discussing would extend the subsidies for two years with new income limits and a $5 monthly minimum out-of-pocket premium, Moreno said, along with new penalties designed to discourage fraud. Starting next year, people who buy health insurance using the subsidies would be able to redirect money to a health savings account if they choose.
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