The US House of Representatives has narrowly passed a Republican backed health care bill that leaves millions of Americans facing higher insurance costs next year, after lawmakers failed to extend enhanced Affordable Care Act subsidies due to expire at the end of December.
The bill cleared the chamber late on Wednesday by a vote of 216 to 211, following a day of intense political drama that exposed deep divisions within the Republican Party. While House Speaker Mike Johnson secured passage of the legislation, the outcome offered little sense of resolution, with party moderates openly rebelling and the bill facing near certain defeat in the Senate.
Without congressional action, enhanced tax credits introduced during the Covid pandemic will lapse on 31 December. According to estimates by the health policy research group KFF, average annual premium payments will rise by $1,016 next year for those currently receiving the additional support.
The legislation approved by the House does not address those subsidies. Instead, it focuses on a set of conservative health policy priorities, including allowing small businesses to band together to offer their own health plans, tightening oversight of pharmacy benefit managers who negotiate drug prices, and funding a separate subsidy intended to reduce out of pocket costs for people enrolled in Affordable Care Act plans.
The vote capped a difficult day for Speaker Johnson, who spent hours attempting to contain an open revolt among centrist Republicans representing competitive districts. Several of those lawmakers have warned for months that allowing the subsidies to expire would expose their constituents to sharp premium increases and could carry significant political consequences in an election year.
“It’s been frustrating I think for a group of us that really wanted to see at least a vote [to extend the subsidies] come to the floor,” said Republican Representative Jen Kiggans of Virginia as she entered the chamber ahead of the vote.
Moderate Republicans had been in talks with party leadership for weeks, seeking a compromise that would at least allow the House to vote on extending the tax credits, even on a temporary or limited basis. When it became clear that the final bill would not include such a provision, some moderates believed they had reached an informal agreement that an amendment could be considered separately.
That understanding collapsed on Wednesday morning, as negotiations broke down between centrists and party leaders, who were also under pressure from hard line conservatives opposed to extending what they see as an expansion of Obamacare.
The impasse triggered a rare and public act of defiance. Four Republican lawmakers joined Democrats in signing a discharge petition, a procedural tool that bypasses party leadership and forces a vote on legislation if enough members support it. The petition would compel the House to vote on a bill extending the Affordable Care Act subsidies for three years.
“They were worried that this bill … if brought to the floor, word for word, would pass. That’s what they were worried about,” said Republican Representative Brian Fitzpatrick of Pennsylvania, referring to his own proposal to extend the subsidies for two years with tighter eligibility rules, including income caps.
The Democratic led discharge petition has now reached the required number of signatures, meaning a vote is expected in January. However, its prospects are bleak. Senate Majority Leader John Thune has said the measure would not advance in the upper chamber, making it effectively symbolic.
Despite the setbacks, moderate Republicans say talks are continuing behind the scenes. Several are now coordinating with Senate colleagues to explore a bipartisan compromise that could clear both chambers. Lawmakers involved in those discussions hope to finalise a proposal before the next government funding deadline on 30 January.
For now, uncertainty remains for millions of Americans who rely on the enhanced subsidies to afford health insurance. With just weeks left before they expire, the political stalemate has left consumers, insurers and state officials bracing for higher costs and renewed instability in the health insurance marketplaces.
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