House Democratic leaders unveiled a healthcare proposal on Tuesday that would extend enhanced Affordable Care Act premium tax credits for three years, offering Republicans what they framed as a final opportunity to prevent millions of Americans from facing skyrocketing medical costs.

The amendment was introduced by House Democratic Leader Hakeem Jeffries and Whip Katherine Clark.

The amendment would extend ACA premium tax credits through 2028, mirroring the same duration Republicans extended the subsidies in 2022. The credits have made health insurance affordable for tens of millions of Americans, with over 22 million people currently enrolled in ACA marketplace plans benefiting from the enhanced assistance.

Without the extension, healthcare premiums would surge catastrophically. The average ACA enrollee would pay $1,904 annually in premiums in 2026—more than double the current $888—representing a 114% increase.​

For middle-income families, the impact would be particularly severe. A 60-year-old couple earning $85,000 annually would see premiums jump by more than $22,600 per year, consuming roughly a quarter of their income. A family of four making $130,000 would face monthly premium payments rising from $921 to $1,998—an annual increase exceeding $12,900.

If the enhanced credits expire, approximately 4 million Americans would lose health insurance coverage by 2034, according to Congressional Budget Office projections. ​The coverage losses would disproportionately affect lower-income Americans and those living in Republican-represented districts.

The proposal also implicitly challenges Republican healthcare priorities established through their “One Big Ugly Bill”—the budget reconciliation legislation Republicans passed earlier in 2025. That law implemented the largest Medicaid cuts in American history, leading to hospital and nursing home closures across the country and forcing community health centers to shutter their doors.

Senate Majority Leader John Thune promised a floor vote by mid-December on legislation to extend the enhanced ACA subsidies, a commitment that persuaded eight Democrats to break with their party and support reopening the government. But House Speaker Mike Johnson (R-LA) repeatedly refused to make the same pledge.