The House on Thursday passed a bill to resurrect health care subsidies that expired last year, as a breakaway faction of House Republicans joined Democrats in a largely symbolic vote that may bring fresh momentum to bipartisan efforts to find a compromise on health care costs.
The measure, which would restore expanded Affordable Care Act tax credits for three years, has no path to enactment given that it has already been rejected by the Senate. But its passage, on a 230-to-196 vote, could fuel ongoing negotiations to reach a long-shot election-year compromise on a health care package.
Democrats, who effectively seized control of the floor and muscled through the legislation over fierce opposition from Speaker Mike Johnson, framed the vote as a victory that validated a risky decision to make the subsidies their central focus during the government shutdown last fall. They erupted in cheers when the measure passed.
“House Democrats have made clear that we will find bipartisan common ground with any of our Republican colleagues in order to address the affordability issues that are making life more expensive,” said Representative Hakeem Jeffries of New York, the minority leader.
By forcing a vote, Democrats pressured Republicans to record a position on the health care legislation, one that Democrats are guaranteed to spotlight in a midterm election year as they try to make affordability the central issue of their campaigns.
At the same time, the House vote offered some political cover to a group of vulnerable Republicans who are facing competitive re-election races and are eager to demonstrate their commitment to addressing soaring premiums. In the end, 17 Republicans joined Democrats, marking a rare occasion where G.O.P. lawmakers voted to bolster a health care law they have long publicly reviled.
Representative Derrick Van Orden, one of the Republicans who crossed party lines, said he still believed the Affordable Care Act “broke” the health care system.
“Philosophically, I completely disagree with this,” said Mr. Van Orden, who represents a competitive district in Wisconsin. “But I’m not going to leave millions of Americans who truly need health care insurance in the lurch.”
And some Republicans who voted for the three-year extension insisted they were not, in fact, voting for that but instead for a yet-to-be-determined Senate compromise that might materialize as a result of the pressure generated by its passage.
“Today’s vote was to move a bill to the Senate so that the Senate could come back with a bipartisan compromise,” Representative Mike Lawler, Republican of New York, said. “The three-year extension is not going to become law.”
Still, Republicans remain deeply divided on a solution. Many conservative lawmakers are opposed outright to the tax credits or to otherwise bolstering the Affordable Care Act, while more moderate representatives like Mr. Lawler have been pushing to extend the subsidies while adding limits that would narrow their reach.
Millions of Americans have relied on the subsidies, which were expanded during the coronavirus pandemic, to help them afford coverage on federal health care exchanges. When they lapsed, the credits returned to the levels that were enacted when the Affordable Care Act was passed in 2010.
For weeks, a shifting bipartisan group of senators has been engaged in regular negotiations over a proposal that could pass both chambers. Some in that faction met on Thursday with members of the House Problem Solvers Caucus, a bipartisan group of centrist representatives, to discuss a possible compromise.
The focus in the Senate talks has been on a two-year extension of the pandemic-era tax credits tied to an income limit and with restrictions imposed to lessen insurance fraud.
“I am hopeful that we will have a consensus bill from our bipartisan group that the House members will endorse next week,” said Senator Susan Collins, Republican of Maine and one of the leaders of the talks.
Whether a deal reached among those negotiators could pass the Senate remains a question, since it will not extend the credits for the three years that Democrats have made their benchmark, and because many Senate Republicans oppose any extension at all.
“They don’t support an extension of a single day of the A.C.A. tax credits, which is the Number One thing to reduce costs immediately,” Senator Chuck Schumer, Democrat of New York and the minority leader, said Thursday.
Several Republicans have also conditioned their support for the measure on the inclusion of language that bars federal funds from being used to pay for abortions. (Most federal funds cannot be used for abortion under a provision known as the Hyde Amendment.)
But Mr. Trump said this week that Republicans would “have to be a little flexible” on the Hyde language, an assertion that was swiftly rejected by many G.O.P. lawmakers and anti-abortion groups who are critical to the party’s base.
Senator John Thune, Republican of South Dakota and the majority leader, said earlier this week that the abortion issue would be a major factor in the Senate.
“Ultimately, we want to ensure that if we do anything, it’s done in a way that reforms these programs and ensures that those dollars aren’t being used to go against the practice that’s been in place for the last 50 years around here when it comes to taxpayer dollars being used to finance abortions,” Mr. Thune said.
Mr. Trump, long a vocal opponent of the Affordable Care Act even though he has never offered an alternative health care plan to replace it, has said that he favors measures that would provide money directly to Americans.
But such a measure failed to pass the Senate last month, and the White House has been virtually absent from the ongoing debate over health care policy.
In the House, Mr. Johnson has been vocally opposed to the extension of the subsidies, which were expanded in 2021 when Democrats controlled both Congress and the White House. Mr. Johnson had been open to allowing moderate Republicans to advance a measure for a vote, but the discussions fell apart over disagreements on the abortion restrictions and how to pay for extending the subsidies.
As a result, four moderate lawmakers defected from Mr. Johnson to sign a Democratic discharge petition pushed by Mr. Jeffries, forcing action on the measure.
Michael Gold covers Congress for The Times, with a focus on immigration policy and congressional oversight.
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