Enhanced ACA subsidies all but doomed as House passes alternative

Modern Healthcare – Wednesday, December 17, 2025
By Michael McAliff

House Republicans muscled through a healthcare bill Wednesday that does not extend the enhanced subsidies for health insurance exchange plans that expire in 15 days.

GOP leaders overcame protests from swing district Republicans aiming to prevent massive premium hikes from hitting their constituents during an election year. A handful of those lawmakers threatened to derail a procedural vote and also signed on a Democratic motion that could force a vote on the subsidies in January.

The House passed the Lower Health Care Premiums for All Americans Act of 2025 on a 216-211 vote. The legislation would not address the subsidies at all but would expand the availability of alternative forms of employee health benefits including association health plans, individual coverage health reimbursement arrangements and catastrophic stop-loss coverage. The bill also includes new regulations on pharmacy benefit managers. Rep. Thomas Massie (Ky.) was the sole Republican to vote no along with all Democrats.

This inaction on the expiring subsidies, created in 2021 as a COVID-19 relief measure, all but guarantees that exchange enrollees will pay substantially more in 2026 and that the ranks of the uninsured will grow. It also ensures that Democrats will continue to hammer the GOP over healthcare costs during midterm election season after centering the issue during the recent government shutdown but coming away empty-handed.

The House-passed bill would reduce federal spending by about $36 billion and cause 100,000 people a year to become uninsured from 2027-2035, according to estimates from the nonpartisan Congressional Budget Office. That’s on top of the 10 million the CBO projected will become uninsured because of the Medicaid and exchange cuts in President Donald Trump’s tax law and the 4 million anticipated to loss coverage when the subsidies revert to the original level from the Affordable Care Act of 2010.

“Democrats have promised that Obamacare would lower costs,” House Ways and Means Committee Chair Jason Smith (R-Mo.) said on the floor before the vote. “Find one American that says that their healthcare is now cheaper today than it was when they passed this disastrous bill.”

Senate Republicans likewise shot down a subsidy extension last week, instead approving a bill that expands health savings accounts.

Congressional Democrats favored a three-year extension of the enhanced subsidies.

“The damage has now been done, no matter what happens, because at this point Republicans have made it impossible to prevent many Americans from paying more on their monthly premiums on Jan. 1,” Senate Minority Leader Chuck Schumer (D-N.Y.) said. “Republicans can’t even say they tried to stop it.”

There remains a slim chance the circumstances may change.

GOP Reps. Rob Bresnahan (Pa.), Brian Fitzpatrick (Pa.), Mike Lawler (N.Y.) and Ryan Mackenzie (Pa.), who face difficult reelection bids, teamed with all 214 House Democrats Wednesday on a procedural tactic that could force a subsidy extension to the House floor.

This bipartisan coalition represents a majority in the House that could advance a subsidies bill via what’s called a discharge petition, which enables members to bypass leaders. The rules governing this process dictate a waiting period, however, meaning any further action would have to hold until Congress returns from its holiday recess next month.

House Minority Leader Hakeem Jeffries (D-N.Y.) characterized this gambit as the only path forward. “We have a bipartisan coalition here in the House of Representatives, at least 218 votes, to extend the Affordable Care Act tax credits for three years, to provide everyday Americans with the certainty that they deserve,” he said.

Jeffries said Democrats would continue to insist on a subsidies vote before the House leaves Washington this week, but Republican leaders are adamantly opposed.

Moreover, last week’s Senate vote demonstrated that there aren’t 60 votes in the upper chamber to block filibusters and allow a subsidy extension to pass. The Senate Democratic bill won a 51-48 majority, with GOP Sens. Susan Collins (Maine), Josh Hawley (Mo.), Lisa Murkowski (Alaska) and Dan Sullivan (Alaska) siding with the minority party.

Some senators are holding bipartisan talks on a compromise. But that is complicated over disagreements about a GOP goal to ban abortion coverage in exchange plans and other matters.

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