The House of Representatives voted Thursday to extend enhanced Affordable Care Act premium tax credits for three years, passing legislation 230-196.
Seventeen House Republicans joined all Democrats in supporting the three-year extension. The bill advanced after House Democrats used a discharge petition, a parliamentary maneuver that required 218 signatures to force consideration of the legislation.
The enhanced tax credits expired at the end of 2025 after Congress failed to reach a deal before the year concluded.
An estimated 22 million of the 24 million ACA marketplace enrollees currently receive these enhanced premium tax credits. According to the Kaiser Family Foundation, the average cost of ACA marketplace plans has increased by 26 percent this year, with some facing even steeper premium spikes without the subsidies.
Senate leadership has already signaled the three-year extension has little chance of passage in its current form. Senate Majority Leader John Thune indicated the chamber would pursue its own path.
Senator Bernie Moreno of Ohio and Senator Susan Collins of Maine are leading negotiations centered on a two-year extension that would include significant reforms. The extension would include an income eligibility cap at 700% of the federal poverty level, a minimum monthly premium of $5, and extended open enrollment through March 1 to allow those who dropped coverage to re-enroll. The proposal would also impose a $1,000 fine for insurance companies that deliberately commit fraud.
Some conservative Republicans are pushing for language ensuring the subsidies cannot fund plans covering abortion. Democrats argue the ACA already includes sufficient Hyde Amendment protections. President Trump has indicated Republicans should remain “flexible” on this issue, though he has previously expressed opposition to extending enhanced subsidies at all.
The Congressional Budget Office estimates the House bill would increase the federal deficit by approximately $80.6 billion over the next decade. However, it would significantly expand coverage, with projections showing an additional 100,000 insured Americans in 2026, growing to 3 million in 2027, 4 million in 2028, and 1.1 million in 2029. The CBO also projects that 6.2 million more people would enroll in ACA marketplace plans by 2029 if the extension becomes law.
Moderate Republican negotiators indicate optimism about reaching a Senate deal. Representative Fitzpatrick told reporters he expects a compromise bill to be drafted early next week.
