The House of Representatives voted Wednesday evening to approve a Republican-backed healthcare bill that fails to extend enhanced Affordable Care Act subsidies.
The legislation, titled the Lower Health Care Premiums for All Americans Act, passed by a narrow margin of 216-211, with all Democrats voting against the measure. The bill now moves to the Senate, where it is considered dead on arrival and unlikely to receive consideration before lawmakers depart for the holiday recess.
The Republican healthcare package focuses on several targeted reforms rather than addressing the expiring subsidies. The legislation would allow small businesses to offer their own association health plans, implement reforms aimed at pharmacy benefit managers to reduce drug costs, and fund cost-sharing reduction subsidies designed to lower out-of-pocket expenses for some ACA enrollees.
However, the bill’s most significant feature is what it omits: any extension of the enhanced premium tax credits that currently help millions of Americans afford health insurance through ACA marketplaces.
Earlier Wednesday morning, four Republicans—Brian Fitzpatrick of Pennsylvania, Mike Lawler of New York, Rob Bresnahan of Pennsylvania, and Ryan Mackenzie of Pennsylvania—took the step of signing onto a Democratic-led discharge petition, which would allow a vote on extend the subsidies.
This move brought the petition to the 218-signature threshold needed to force a floor vote on legislation that would extend the enhanced ACA subsidies for three years, circumventing House leadership entirely.
The successful discharge petition has teed up a floor vote for early in the new year, though discharge petitions typically require a seven-day waiting period before legislation can come to the floor. With the House set to depart for holiday recess this week, the vote won’t occur until January.
House GOP moderates are now discussing options with their Senate counterparts about a bipartisan compromise bill that could pass both chambers before the next government funding deadline on January 30.
The expiration of enhanced tax credits is projected to have severe financial consequences for millions of Americans. According to the Kaiser Family Foundation, premium payments will increase by an average of $1,016 next year if the enhanced tax credits expire on December 31. For subsidized enrollees, this represents a 114% increase, with average annual payments jumping from $888 in 2025 to $1,904 in 2026.
The impact will be particularly acute for middle-income Americans and older enrollees. A 60-year-old couple making $85,000 annually would see their yearly premium payments rise by over $22,600 in 2026. The Congressional Budget Office estimates that an average of 100,000 fewer people per year from 2027 to 2035 would have health insurance under the GOP plan.
Insurers participating in ACA marketplaces are proposing premium increases with a median of 18% for 2026, fueled by rising healthcare costs and the expiration of enhanced subsidies—the largest rate increases since 2018.
