An expanded federal healthcare subsidy that grew out of the pandemic looks all but certain to expire on December 31, as Republican leaders in the United States faced a rebellion from within their own ranks.
On Wednesday, four centrist Republicans in the House of Representatives broke with their party’s leadership to support a Democratic-backed extension for the healthcare subsidies under the Affordable Care Act (ACA), sometimes called “Obamacare”.
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By a vote of 204 to 203, the House voted to stop the last-minute move by Democrats, aided by four Republicans, to force quick votes on a three-year extension of the Affordable Care Act subsidy.
Democrats loudly protested, accusing Republican leadership of gavelling an end to the vote prematurely while some members were still trying to vote.
“That’s outrageous,” Democratic Representative Jim McGovern of Massachusetts yelled at Republican leadership.
Some of the 24 million Americans who buy their health insurance through the ACA programme could face sharply higher costs beginning on January 1 without action by Congress.
Twenty-six House members had not yet voted – and some were actively trying to do so – when the House Republican leadership gavelled the vote closed on Wednesday. It is rare but not unprecedented for House leadership to cut a contested vote short.
Democratic Representative Rosa DeLauro of Connecticut said the decision prevented some Democrats from voting.
“Listen, it’s playing games when people’s lives are at stake,” DeLauro said. “They jettisoned it.”
It was the latest episode of congressional discord over the subsidies, which are slated to expire at the end of the year.
The vote also offered another key test to the Republican leadership of House Speaker Mike Johnson. Normally, Johnson determines which bills to bring to a House vote, but recently, his power has been circumvented by a series of “discharge petitions”, wherein a majority of representatives sign a petition to force a vote.
In a series of quickfire manoeuvres on Wednesday, Democrats resorted to one such discharge petition to force a vote on the healthcare subsidies in the new year.
They were joined by the four centrist Republicans: Mike Lawler of New York and Brian Fitzpatrick, Robert Bresnahan and Ryan MacKenzie of Pennsylvania.
The Democratic proposal would see the subsidies extended for three years.
But Republicans have largely rallied around their own proposal, a bill called the Lower Health Care Premiums for All Americans Act. It would reduce some insurance premiums, though critics argue it would raise others, and it would also reduce healthcare subsidies overall.
The nonpartisan Congressional Budget Office (CBO) on Tuesday said the legislation would decrease the number of people with health insurance by an average of 100,000 per year through 2035.
Its money-saving provisions would reduce federal deficits by $35.6bn, the CBO said.
Republicans have a narrow 220-seat majority in the 435-seat House of Representatives, and Democrats are hoping to flip the chamber to their control in the 2026 midterm elections.
Three of the four Republicans who sided with the Democrats over the discharge petition are from the swing state of Pennsylvania, where voters could lean right or left.
Affordability has emerged as a central question ahead of the 2026 midterms.
Even if the Republican-controlled House manages to pass a healthcare bill this week, it is unlikely to be taken up by the Senate before Congress begins a looming end-of-year recess that would stop legislative action until January 5.
By then, millions of Americans will be looking at significantly more expensive health insurance premiums that could prompt some to go without coverage.
Wednesday’s House floor battle could embolden Democrats and some Republicans to revisit the issue in January, even though higher premiums will already be in the pipeline.
Referring to the House debate, moderate Republican Senator Lisa Murkowski told reporters: “I think that that will help prompt a response here in the Senate after the first of the new year, and I’m looking forward to that.”
The ACA subsidies were a major point of friction earlier this year as well, during the historic 43-day government shutdown.
Democrats had hoped to extend the subsidies during the debate over government spending, but Republican leaders refused to take up the issue until a continuing budget resolution was passed first.