A group of moderate Republicans joined with House Democrats on Wednesday in an effort to force a vote on extending enhanced subsidies for insurance plans covered under the Affordable Care Act. The vote is unlikely to take place before January, even though the subsidies are set to expire Dec. 31.
The procedural move, enabled by four House Republicans, came a day after House Speaker Mike Johnson, R-La., ruled out a vote on extending the subsidies, even for a short period, saying it was “not to be.”
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But in defiance of Johnson, four Republicans joined Democrats and signed a discharge petition to force a vote on legislation that would extend the credits for three years.
Discharge petitions have a seven-day waiting period, and Congress goes into recess at the end of the week. That could allow Johnson to block a vote, at least until the House returns from its holiday break in early January — after the subsidies have expired.
Johnson has adamantly opposed extending the subsidies and criticized Republicans who signed the petition.
“Doing an end-run around the majority party, the Speaker, or the regular process is not the best way to make law,” Johnson told CNBC’s “Squawk Box” on Wednesday.
Unless Congress acts this week, the tax credits that lowered the price of health insurance premiums for 20 million Americans are likely to expire, at least temporarily.
Johnson and other GOP politicians are advancing a separate health reform package that does not include a subsidy extension. The House is expected to vote on that bill and two others aimed at restricting gender-affirming care this week.
Votes blocked in the Senate
Last week, the Senate blocked votes on two competing proposals aimed at addressing rising health care costs and expiring Affordable Care Act (ACA) subsidies.
The first bill, brought by Sens. Mike Crapo, R-Idaho, and Bill Cassidy, R-La., proposed routing federal funds directly to Americans through health savings accounts, or HSAs, rather than through subsidies paid to health insurance companies. A second Democrat-sponsored bill proposed to extend ACA subsidies for three years.
Neither bill garnered enough support for a full vote.
ACA subsidies
The Affordable Care Act introduced federal subsidies when it passed in 2010. These original subsidies lowered the price of health insurance only for low-income Americans. In 2021, a COVID-era law expanded the original subsidies to all Americans regardless of income and eliminated health insurance premiums for the lowest-income households. A 2022 law extended these tax credits through 2025.
Throughout October and early November, Republicans and Democrats were deadlocked over again extending these enhanced subsidies, leading to the longest federal government shutdown in history. In a deal to reopen the government, Democrats conceded, and Republicans agreed to bring the issue up for a vote in December.
Many Republican lawmakers have long argued that these subsidies fuel “waste, fraud, and abuse” and enrich insurance companies.
“There is nothing in [Democrats’] bill that stops billions of dollars in fraudulent spending,” Cassidy said on the Senate floor last week.
Democrats and a growing number of moderate Republicans are calling for an extension.
“There is a runaway train barreling towards our country in the form of a massive increase in health care costs for millions of Americans that are tied to the tracks,” Sen. Ron Wyden, D-Ore., said last week before the Senate voted on its two health bills.
“I am pissed for the American people. This is absolute b——,” Rep. Mike Lawler, R-NY, said after Tuesday’s failed vote in the House.
Other House health care bills
Last week, Johnson unveiled his own health care bill, dubbed the Lower Health Care Premiums for All Americans Act.
This bill allocates cost-sharing reduction payments to lower insurance premiums for low-income Americans starting in 2027. The bill also calls for pharmacy benefit managers — companies that negotiate the price of drugs with pharmaceutical companies on behalf of insurance companies — to provide employers with detailed data on prescription drug spending. Johnson’s proposed act also expands access to association health plans, where multiple employers join together to offer medical benefits.
The House is also expected to vote on two other health bills this week; both aim to restrict youth access to gender-affirming care. One bill, introduced by Marjorie Taylor Greene, R-Ga., would classify transition-related care for minors as “genital and bodily mutilation and chemical castration.” The bill would make it a felony to perform those procedures. A separate bill would prohibit Medicaid funding for puberty blockers, hormone therapy, surgery, and other gender-affirming care.
