Health insurance exchange subsidies extension clears House

Modern Healthcare – Thursday, January 8, 2026
By Michael McAuliff

The House approved legislation Thursday that would restore the enhanced subsidies for health insurance enrollees that expired at the end of 2025.

Seventeen Republicans broke with House Speaker Mike Johnson (R-La.) and voted with the Democratic minority on the three-year extension, which is retroactive to Jan. 1, and the measure passed 230-196.

The same legislation fell nine votes short of the 60 needed to block filibusters in the Senate last month, however, making it unlikely to wind up on President Donald Trump’s desk.

The furor over soaring exchange premiums and the GOP defections in the House may, however, intensify bipartisan negotiations in the Senate that could still lead to some form of subsidy extension.

While details remain in flux, talks are centered on a proposal to retain the enhanced subsidies for two years, cap eligibility at 700% of the federal poverty poverty level — $109,550 for a single person — impose a minimum monthly premium, and expand health savings accounts.

Abortion has emerged as the major sticking point as Republicans insist on provisions to bar health insurance exchange plans from covering abortion care, which Democrats adamantly oppose.

On Tuesday, Trump urged Republicans to be “flexible” on abortion. But GOP senators strongly want to restrict abortion coverage, said Sen. Josh Hawley (Mo.), one of the four Republicans who voted for the Democratic subsidy extension bill last month.

“We’ve got to get somewhere on that,” Hawley said. “There needs to be something meaningful.”

The House bill, sponsored by Minority Leader Hakeem Jeffries (D-N.Y.), only made it to the floor via an uncommon procedural tool known as a discharge petition.

Under House rules, a majority of members can force votes on legislation that leaders don’t support. Four House Republicans signed the Democratic discharge petition last month when Johnson refused to allow the chamber to consider a subsidy extension.

The nonpartisan Congressional Budget Office projected that the House-passed bill would have little effect on the number of people with health coverage or on exchange premiums this year, but would increase coverage and reduce premiums in future years.

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