• Bill extends premium tax credits for three years affecting 22 million Americans
• Senate unlikely to pass measure without compromise including income caps, abortion restrictions
• Discharge petition forced vote after Speaker Johnson blocked legislation

WASHINGTON (TDR) — The House of Representatives passed legislation Thursday to restore expired Affordable Care Act subsidies in a 230-196 vote, with 17 Republicans breaking ranks to support the three-year extension despite opposition from Speaker Mike Johnson and President Donald Trump.

The vote represents a rare legislative rebuke of GOP leadership on a key healthcare affordability issue ahead of November’s midterm elections. However, the bill faces steep odds in the Senate, where a similar measure failed in December and bipartisan negotiations continue over compromise provisions.

“The affordability crisis is not a ‘hoax,’ it is very real — despite what Donald Trump has had to say. Today we have an opportunity to take a meaningful step forward.”

Discharge Petition Bypassed Leadership

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The legislation reached the House floor only after four moderate Republicans signed a Democratic discharge petition in December, forcing a vote over Johnson’s objections. The procedural maneuver requires 218 signatures to bypass leadership and bring legislation directly to the floor.

House Minority Leader Hakeem Jeffries launched the petition after Republican leaders refused to consider renewing the enhanced premium tax credits that expired December 31, 2025. The credits had been a central demand during last fall’s record 43-day government shutdown.

Wednesday’s procedural vote passed 221-205 with nine Republicans joining Democrats. By Thursday’s final vote, 17 Republicans supported the measure: Representatives Robert Bresnahan, Mike Carey, Monica De La Cruz, Brian Fitzpatrick, Andrew Garbarino, Jeff Hurd, Dave Joyce, Tom Kean Jr., Nick LaLota, Mike Lawler, Ryan Mackenzie, Carol Miller, Zach Nunn, María Elvira Salazar, David Valadao, Derrick Van Orden and Rob Wittman.

Premium Costs Skyrocket for Millions

Approximately 22 million of the 24 million ACA marketplace enrollees currently receive enhanced premium tax credits to lower monthly insurance costs. Without extension, the Kaiser Family Foundation projected out-of-pocket premium costs would more than double, increasing an average of 114%.

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The Congressional Budget Office estimates the three-year extension would increase the federal deficit by $80.6 billion over the next decade while providing coverage to 4 million additional people by 2028.

Most breakaway GOP lawmakers represent swing districts facing competitive 2026 midterm races where healthcare costs could prove politically damaging.

Senate Compromise Negotiations Continue

Senate Majority Leader John Thune indicated Thursday there exists “no appetite” in the upper chamber for a clean three-year extension, pointing instead to ongoing bipartisan negotiations. The Senate rejected a similar measure in December, though four Republicans — Senators Susan Collins, Josh Hawley, Lisa Murkowski and Dan Sullivan — crossed party lines in support.

A bipartisan working group met Thursday to hammer out compromise legislation that could attract sufficient Republican support. Senator Bernie Moreno is pushing a two-year extension with several modifications including limiting eligibility to 700% of the poverty level and a minimum premium of $5 monthly even for lowest earners.

The compromise proposal would allow enrollees to redirect enhanced tax credits to health savings accounts starting in the second year. Negotiators reported agreement on addressing widespread fraud through measures targeting phantom accounts, though specific legislative language remains under development.

Abortion Restrictions Remain Sticking Point

The primary obstacle preventing bipartisan agreement involves the Hyde Amendment, which prohibits federal funding for most abortion services. Many Republicans insist on strengthening Hyde protections to ensure subsidy extensions don’t provide federal funds for abortion coverage, generating Democratic opposition.

Trump earlier this week told House Republicans to be “flexible” on Hyde Amendment restrictions, prompting pushback from conservative members. “We don’t do federal funding for abortions,” Moreno stated. “That’s a long-standing tradition, nobody’s looking to change that.”

CNN reported Thursday that some GOP senators privately expressed openness to leaving Hyde Amendment language as currently written rather than adding new restrictions, potentially opening a path toward compromise.

Senator Jeanne Shaheen told reporters that bipartisan negotiators reached agreement on fraud prevention measures and planned to draft bill text in coming days. “We’re trying to see if we can get to some agreement that’s going to help them, and the sooner we can do that, the better,” the New Hampshire Democrat said.

Can lawmakers overcome abortion politics to restore healthcare subsidies before millions lose coverage permanently?

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