Federal health aid expanded in the wake of the pandemic appears almost certain to expire on December 31, as the US Republican leadership faces an internal revolt.
Four centrist Republicans in the House on Wednesday broke with party leadership and supported extending health care subsidies under the Democratic-backed Affordable Care Act (ACA), also known as “Obamacare.”
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The House voted 204-203 to block a last-ditch effort by Democrats, backed by four Republicans, to force an immediate vote on a three-year extension of Affordable Care Act subsidies.
Democrats loudly protested and accused Republican leaders of prematurely ending voting while some lawmakers were still trying to vote.
“This is outrageous,” Democratic Representative Jim McGovern of Massachusetts yelled at Republican leaders.
Some of the 24 million Americans who purchase health insurance through the ACA program could face significant cost increases starting January 1 without action from Congress.
When House Republican leaders closed voting on Wednesday, 26 House members had not yet voted, and some were actively trying to vote. While it is unusual for House leadership to shorten a contested vote, it is not unprecedented.
Democratic Representative Rosa DeLauro of Connecticut said the decision prevented some Democrats from voting.
“Listen, you’re playing games when people’s lives are at risk,” DeLauro said. “They threw it away.”
It was the latest episode in a standoff in Congress over the subsidy, which is set to expire at the end of the year.
The vote also marked another important test for House Speaker Mike Johnson’s Republican leadership. Mr Johnson usually decides which bills come to a vote in the House of Commons, but his powers have recently been circumvented by a series of “removal petitions” in which a majority of MPs sign a petition to force a vote.
In a series of hasty maneuvers Wednesday, Democrats resorted to one such dismissal petition to force a vote on health care subsidies in the new year.
They were joined by four moderate Republicans: Mike Lawler of New York and Brian Fitzpatrick, Robert Bresnahan and Ryan McKenzie of Pennsylvania.
Under the Democratic Party’s plan, the subsidy would be extended for three years.
But Republicans have largely rallied around his proposal, a bill called the National Health Insurance Premium Reduction Act. While some premiums would be lowered, critics say it would raise other premiums and reduce overall health care subsidies.
The nonpartisan Congressional Budget Office (CBO) announced Tuesday that the bill would reduce the number of people with health insurance by an average of 100,000 people a year through 2035.
CBO said its savings provisions would reduce the federal deficit by $35.6 billion.
Republicans hold a narrow 220-seat majority in the 435-member House, and Democrats hope to regain control of the chamber in the 2026 midterm elections.
Three of the four Republicans who sided with Democrats on the discharge petition are from Pennsylvania, a battleground state where voters can lean left or right.
Affordability has emerged as a central issue in the lead-up to the 2026 midterm elections.
Even if the Republican-controlled House manages to pass the health care bill this week, it is unlikely to be considered by the Senate before Congress enters its looming year-end recess, which suspends legislative activity until January 5.
By then, millions of Americans will be looking at significantly higher health insurance premiums, and some may become uninsured.
Even though premium increases are already scheduled, Wednesday’s full House session could embolden Democrats and some Republicans to revisit the issue in January.
Sen. Lisa Murkowski, a moderate Republican, referred to the House debate and told reporters, “I think it will help prompt a response here in the Senate in the new year, and I look forward to that.”
ACA subsidies were also a major point of friction during the historic 43-day government shutdown earlier this year.
Democrats had wanted 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.
