The U.S. Capitol in Washington, D.C., on Oct. 1, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — Republican leaders in the U.S. House will face a floor vote in early 2026 on Democrats’ plan to extend enhanced Affordable Care Act tax credits for three more years, after passing their own legislation Wednesday night that has little chance of a future in the Senate and does not address the tax credits.

The House vote on that legislation will be required after a handful of moderate Republicans signed on to a discharge petition Wednesday morning. Their dissent with leadership sent a strong signal they are frustrated with the majority’s policies and the rising cost of health care for their constituents. 

Speaker Mike Johnson, R-La., said after a morning vote series on the floor, where he was seen in a heated exchange with Republican Rep. Mike Lawler, that the two “just had some intense fellowship” and “it’s all good.”

Lawler is one of the four centrist Republicans who signed the discharge petition, putting it over the threshold of 218 to force a vote on the legislation. 

“We’re working through very complex issues as we do here all the time,” Johnson said. “Everybody’s working towards ideas — we’re keeping the productive conversation going.” 

The speaker also mounted his own defense, saying he has “not lost control of the House.”

That chamber has seen chaos and intraparty divides in the aftermath of the government shutdown, when Johnson opted to send lawmakers home for nearly two months. 

“We have the smallest majority in U.S. history,” Johnson said. “These are not normal times — there are processes and procedures in the House that are less frequently used when there are larger majorities, and when you have the luxury of having 10 or 15 people who disagree on something, you don’t have to deal with it, but when you have a razor-thin margin, as we do, then all the procedures in the book people think are on the table, and that’s the difference.”

Republicans push through ‘extremely modest’ bill

House debate on Republican leaders’ health care bill later in the day was largely along party lines, with members of both parties talking nearly as much about the Affordable Care Act as they did about the policy in the new legislation. 

Energy and Commerce Committee Chairman Brett Guthrie, R-Ky., said he believes that law, enacted during President Barack Obama’s first term, “has proven to be unaffordable and unsustainable.” 

Guthrie rebuked Democrats for approving the enhanced ACA marketplace tax credits during the coronavirus pandemic and scheduling them to expire at the end of this year, leading to the current deadlock in Congress. 

“Democrats leveraged a public health emergency to shovel hundreds of billions of dollars to big health insurance plans to mask the risk of rising unaffordability of coverage,” Guthrie said.

House Minority Leader Hakeem Jeffries, D-N.Y., urged Johnson to put the three-year ACA extension bill up for a vote this week, instead of in the new year. 

“Republicans need to bring the Affordable Care Act tax credit extension bill to the floor today,” Jeffries said. “Under no circumstances should we leave this Capitol this week, before voting on an extension of the Affordable Care Act tax credit bill that we know will pass.” 

California Republican Rep. Kevin Kiley, one of the centrists looking for bipartisan solutions on the expiring tax credits, expressed dismay at how debate on health care costs has been handled during the past few months by leaders in both political parties. 

“This whole issue encapsulates what is wrong with this institution, where party leaders focus most of their time and energy on trying to blame problems on the other side rather than trying to solve those problems,” Kiley said. 

The House Republican bill, he said, is “extremely modest and it has no chance of becoming law because it was hastily thrown together without, apparently, any bipartisan input when bipartisan support is necessary to pass any measure like this.”

“What are we supposed to tell these folks? ‘Oh, don’t worry, it’s Obama’s fault.’ Or, ‘Oh no don’t worry, we did a show vote on this Lower Health Care Premiums for All Americans Act.’ Is that going to be any consolation?” Kiley said. 

New Jersey Democratic Rep. Frank Pallone called the House GOP bill a “sham” and said without a vote to extend the expiring ACA tax credits millions of Americans will have to decide if they can afford health insurance coverage. 

“They will see prices double, triple and even quadruple,” Pallone said. “It will leave millions with the difficult decision of going without coverage because they simply cannot afford rising costs.”

The House voted 216-211 to approve the Republican health care bill, sending it to the Senate, where it’s highly unlikely it would get the bipartisan support needed to advance without significant revision. 

Senate approach

Senate Majority Leader John Thune, R-S.D., said earlier in the day he hadn’t yet decided whether to put the House Democrats’ bill on the floor if it is passed and arrives. 

“Well, we’ll see. I mean, we obviously will cross that bridge when we come to it,” Thune said. “Even if they have a sufficient number of signatures, I doubt they vote on it this week.”

Thune said the discharge petition on the three-year ACA tax credits extension is far different from the discharge petition that forced a House floor vote on a bill to require the release of the Epstein files. Files related to Jeffrey Epstein, who died in jail in 2019 awaiting federal trial on sex trafficking charges, have become a target of Congress and victims in recent months.

“That came over here pretty much unanimously, 427 to 1,” Thune said. 
“And my assumption is this discharge petition is going to be a very, probably, partisan vote.”

The Senate voted earlier this month on Democrats’ three-year ACA tax credits legislation, a move that Thune agreed to in order to get enough Democratic votes to end the government shutdown. That bill, which is identical to the House version, was unable to get the 60 votes needed to advance on a 51-48 vote. 

Both chambers are set to leave Capitol Hill later this week for their two-week winter break and won’t return to work until the week of Jan. 5. 

‘We have to do something’ 

Sen. Jeanne Shaheen said she sees the House discharge petition reaching the 218-signature threshold as “constructive.” 

The New Hampshire Democrat said “bipartisan, bicameral talks continue that are also constructive, so hopefully we can see some movement.” 

Though she is “hopeful” for a deal in January, Shaheen said “obviously, there’s a lot that needs to happen in order to get something done, but people need relief,” adding that “people in both houses and on both sides of the aisle are hearing from constituents that they want to see something done.” 

Missouri Sen. Josh Hawley — one of four Republicans who voted with Democrats to advance the three-year extension plan — reiterated his calls for lawmakers to take action to address the looming premium spikes. 

“I just think we have to do something on the cost of premiums, and I’m not locked into any one thing,” he said, acknowledging that he voted for both Democrats’ proposal and his GOP colleagues’ alternative bill. That effort also failed, at 51-48, to garner the 60 votes needed to move forward.  

“I mean, advance any solution — that’s my view, but what I think we should not do is just sit back and say, ‘Well, you know, good luck. We wish you all the best.’” 

Frustration breaks through

The House Republican bill, which Johnson released Friday evening, doesn’t extend the enhanced ACA marketplace tax credits.

It would require Pharmacy Benefit Managers “to provide employers with detailed data on prescription drug spending, rebates, spread pricing, and formulary decisions—empowering plans and workers with the transparency they deserve,” according to a summary in Johnson’s release. 

Starting in 2027, the legislation would appropriate funding for cost sharing reduction payments that the summary said would reduce health insurance premiums and stabilize the individual market. 

Johnson decided Tuesday not to allow the House to debate any amendments to the bill, blocking moderate Republicans from having their bipartisan proposal to extend the ACA marketplace tax credits with modifications taken up. 

That led to considerable frustration, and Wednesday morning, Pennsylvania Republican Reps. Brian Fitzpatrick, Rob Bresnahan and Ryan Mackenzie, along with New York’s Lawler, signed the Democrats’ discharge petition, putting it at the 218 signatures needed to force a floor vote in that chamber. 

“We’ve worked for months with both parties, in both chambers, and with the White House, all in good faith, to balance all equities and offer a responsible bridge that successfully threaded the needle,” Fitzpatrick wrote in a statement.   

“Our only request was a Floor vote on this compromise, so that the American People’s voice could be heard on this issue,” Fitzpatrick added. “That request was rejected. Then, at the request of House leadership I, along with my colleagues, filed multiple amendments, and testified at length to those amendments. House leadership then decided to reject every single one of these amendments. As I’ve stated many times before, the only policy that is worse than a clean three-year extension without any reforms, is a policy of complete expiration without any bridge. Unfortunately, it is House leadership themselves that have forced this outcome.”

Jeffries introduced petition

The discharge petition, introduced last month by House Democratic Leader  Jeffries, sat just below the signatures needed for weeks as centrist Republicans tried to broker a deal that could become law. 

When that logjam broke with the moderates’ signatures, it set up a House floor vote, but any legislation must move through the Senate as well and gain President Donald Trump’s signature. 

Without a law to extend the enhanced ACA marketplace subsidies, roughly 22 million Americans will see their health insurance premiums spike by thousands of dollars next year, if they can fit the rise in costs into their budgets. 

U.S. House Speaker Mike Johnson, R-La., talks with reporters inside the U.S. Capitol on Tuesday, Oct. 21, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Speaker Mike Johnson said Tuesday he will not allow a floor vote this week on a bipartisan amendment supported by moderate Republicans that would extend the Affordable Care Act enhanced tax credits. 

Johnson was confident that blocking the amendment would not lead centrist GOP lawmakers to oppose the Republican health care bill scheduled to get a vote Wednesday. 

“There’s about a dozen members in the conference that are in these swing districts who are fighting hard to make sure they reduce costs for all of their constituents. And many of them did want to vote on this Obamacare, COVID-era subsidy the Democrats created,” Johnson said. “We looked for a way to try to allow for that pressure release valve and it just was not to be.”

The enhanced ACA tax credits are set to expire at the end of the year, sharply increasing the cost of health insurance for the roughly 22 million Americans who purchase plans through the exchange and benefit from the subsidies. 

The House Republican health care bill wouldn’t extend those tax credits, frustrating GOP lawmakers in that chamber who are most at risk of losing their reelection bids during the November midterm elections. 

Johnson said he expects that GOP bill will pass, though he didn’t address its prospects in the Senate, where bipartisanship is needed for nearly all bills to advance under that chamber’s 60-vote legislative filibuster. 

The nonpartisan Congressional Budget Office and the staff of the Joint Committee on Taxation’s analysis of the bill shows it would reduce the federal deficit by $35.6 billion during the next decade. 

An average of 100,000 people per year would lose health insurance between 2027 and 2035, while  gross benchmark premiums for health insurance would drop by 11% on average through 2035, according to the joint analysis. 

‘Idiotic and shameful’

New York Republican Rep. Mike Lawler said in a speech on the House floor that GOP leaders’ decision to let the enhanced ACA tax credits expire was “idiotic and shameful,” especially after changes were added to address fraud and reduce costs. 

“So we have been forced to sign onto two discharge petitions,” he said. “And yet my Democratic colleagues will not join us, but for those that were at the negotiation table.”

Lawler then criticized House Minority Leader Hakeem Jeffries, of New York, for not encouraging Democrats to sign onto the bipartisan discharge petitions, noting that would likely get the 218 signatures needed to force a floor vote. He argued that’s because Jeffries “doesn’t actually want to solve the problem, he wants the issue.”

“This place is disgraceful,” Lawler said. “Everybody wants the upper hand.  Everybody wants the political advantage. They don’t actually want to do the damn work. This problem could be solved today if everybody who says they care about extending this signs the discharge.”

GOP-only bill in 2026?

When the House returns from its two-week holiday break next year, Johnson said, leaders may try to use the complex reconciliation process they used to enact the “one big, beautiful bill” to address health care. 

“What we anticipate going into the first quarter of next year is, possibly in a reconciliation package or in regular order a stand-alone, ideas just like this,” Johnson said after being asked a question about Health Savings Accounts. “We have a long list of things that we know will reduce premiums, increase access and quality of care.” 

President Donald Trump said Monday he wants Republicans to use the reconciliation process or to eliminate the Senate’s legislative filibuster to address health care and other policy priorities. 

“Republicans should knock out the filibuster and we should approve a lot of things,” Trump said. 

Senate Majority Leader John Thune, R-S.D., has said repeatedly he doesn’t intend to change or scrap the filibuster.

Direct payments or tax breaks

Trump also reiterated during the Oval Office event he would like to see Congress send direct payments to Americans to help them buy health insurance or afford health care. 

“I want all money going to the people and let the people buy their own health care. It’ll be unbelievable,” Trump said. “They’ll do a great job. They’ll get much better health care at a much lower cost.”

The Senate voted last week on two health care bills, one from Republicans and one from Democrats, but neither received the support needed to move toward a final passage vote. 

Republicans’ bill would have provided direct payments to some people enrolled in either bronze or catastrophic ACA marketplace plans with up to $1,500 in payments annually for 2026 and 2027. 

Democrats’ legislation would have extended the enhanced ACA marketplace tax credits for three years. 

Cost most urgent issue, poll finds

A bipartisan group of senators is trying to find solutions that bridge the political divide, though they are unlikely to achieve consensus on the details before the end of this week.

Thune said during a press conference Tuesday he believes there’s a way to address the rising costs of health care if Democrats continue negotiations with Republicans. 

“Our views on health care and the Democratic views on health care are very different. And I think that’s a difficult challenge that we have to figure out how to overcome,” Thune said. “But if they’re willing to accept changes that actually would put more power and control and resources in the hands of the American people and less of that in the pockets of the insurance companies, then I think there is a path forward.”

Thune acknowledged that Congress cannot pass anything this week but said he believes “there’s a potential pathway in January if Democrats are willing to come to the table on things that will actually drive down the costs of health care.”

Senate Minority Leader Chuck Schumer, D-N.Y., didn’t entirely rule out using the Jan. 30 government funding deadline to force a partial shutdown over health care, though he implied nothing can be done on the ACA tax credits after they expire at the end of December. 

“Once it expires, the toothpaste is out of the tube,” Schumer said. 

A poll released Monday by the West Health-Gallup Center on Healthcare in America shows that cost is the “most urgent” health issue facing the country, followed by access and then obesity. 

Just 57% of those polled said they were satisfied with how much they pay for their own health care and only 16% were satisfied with the total cost of health care.

Nearly two-thirds of those in the survey said they believe it’s the federal government’s responsibility “to make sure all Americans have healthcare coverage,” while 33% said it’s not. 

U.S. House Speaker Mike Johnson, R-La., talks with reporters during a press conference on Wednesday, Dec. 10, 2025. Also pictured are, from left, Republican Conference Chairwoman Lisa McClain of Michigan, Majority Whip Tom Emmer of Minnesota and Majority Leader Steve Scalise of Louisiana. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Republicans released a health care bill Friday evening they hope will help curb rising costs, though the measure doesn’t have the level of Democratic support needed to get through the Senate. 

The 111-page bill will likely move to the House floor next week, where Speaker Mike Johnson will need nearly every one of his members to vote to pass the legislation, an uphill battle given the vastly different views among centrists and far-right members of the party on health care issues. 

The Louisiana Republican said in a statement the bill offers “clear, responsible alternatives that will lower premium costs and increase access and health care options for all Americans.”

Democrats have been pressing for a three-year extension of the enhanced tax credits for people who purchase their insurance through the Affordable Care Act marketplace. 

So far, House and Senate Republican leadership hasn’t gotten on board with any extension of those subsidies, arguing they have led to a sharp rise in the cost of health insurance. 

GOP lawmakers have instead pursued their own legislation, but without at least some backing from Democrats, no bill will make it through the Senate’s 60-vote procedural hurdles. 

Senate Republicans tried to advance a bill earlier this week from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo but fell short of the votes needed. 

Democrats were also unsuccessful trying to move their bill to extend the ACA marketplace tax credits for three years. 

The House Republican bill, sponsored by Iowa Republican Mariannette Miller-Meeks, is unlikely to break the logjam in Congress over the rising cost of health insurance and health care, potentially leaving the issue as one the parties can debate leading up to next year’s midterm elections. 

Targeting ‘real drivers’ of cost increases

Johnson rebuked Democrats in his statement for enacting the Affordable Care Act during President Barack Obama’s first term, saying the law hasn’t made health care cost less. 

House Republicans’ new legislation, Johnson said, will address “the real drivers of health care costs to provide affordable care, increase access and choice, and restore integrity to our nation’s health care system for all Americans.”

The bill would require Pharmacy Benefit Managers “to provide employers with detailed data on prescription drug spending, rebates, spread pricing, and formulary decisions—empowering plans and workers with the transparency they deserve,” according to a summary in Johnson’s release. 

Starting in 2027, the legislation would appropriate funding for cost sharing reduction payments that the summary said would reduce health insurance premiums and stabilize the individual market. 

The House Rules Committee is scheduled to prepare the bill for floor debate on Tuesday by considering whether to allow any amendments to be considered on the floor. 

The full House will then debate the legislation later in the week before departing for the two-week holiday break. 

Trump wants direct payments

President Donald Trump, speaking from the Oval Office shortly after the bill was released, reiterated his preference that the federal government send payments directly to Americans.

“We want to give the money to the people and let the people buy their own great health care, and they’ll save a lot of money, and it’ll be great,” he said.

But Trump also appeared to signal he is going to stay out of negotiations in Congress, saying, “I leave it to them and hopefully they’re going to put great legislation on this desk right here.”

Sen. Bill Cassidy, R-La., answers questions from reporters after chairing a hearing of the Senate Health, Education, Labor and Pensions Committee on Sept. 17, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. Senate Republicans announced Tuesday they will hold a vote on their own health care proposal later this week to counter a Democratic bill that would extend enhanced tax credits for Affordable Care Act marketplace plans for three more years.

The 32-page GOP bill would not address the expiring ACA marketplace tax credits but would send payments to certain Americans through Health Savings Accounts to cover some of the cost of health care. 

Neither measure has the 60 votes needed to advance under that chamber’s rules. That would leave the ACA marketplace subsidies to expire at the end of the year and dramatically spike the cost of health insurance for the millions of people enrolled in those plans. 

Senate Majority Leader John Thune, R-S.D., said Democrats’ bill to simply extend the enhanced ACA marketplace tax credits to offset the costs Americans pay for that insurance was unacceptable. 

“The way that the program is structured, the money goes straight to the insurance companies,” Thune said. “And the way that we think this ought to work is you ought to come up with a way in which you can deliver the benefit to the patients and not to the insurance companies.”

Thune said the Democratic bill lacks an income cap for ACA marketplace tax credits and allows $0 premiums for health insurance plans — guaranteeing the measure will fail.

Senate Democratic Leader Chuck Schumer, of New York, called the GOP proposal a “nonstarter” that would lead to “junk insurance.” He said the only way to avoid a dramatic increase in health insurance costs next year is to extend the enhanced ACA tax credits. 

“Their phony proposal is dead on arrival,” Schumer said. “The bill not only fails to extend the tax credits, it increases costs, adds tons of new abortion restrictions for women, expands junk fees and permanently funds cost-sharing reductions.”

Multiple plans

Senate Republicans have debated for weeks whether to hold a vote on a GOP plan to show the party has something to offer toward reducing health care costs. Thune promised Democrats a vote on a health care bill of their choosing in exchange for votes to end the government shutdown. 

Schumer announced last week that Democrats would hold the vote on a three-year extension of the enhanced ACA tax credits as they exist now. 

Several GOP senators, including Maine’s Susan Collins and Ohio’s Bernie Moreno, have released plans that would include an extension of the expiring tax credits while beginning to transition away from those subsidies. 

But Republican leaders ultimately decided to hold a vote on a proposal released earlier this week by Health, Education, Labor and Pensions Committee Chairman Bill Cassidy, R-La., and Finance Committee Chairman Mike Crapo, R-Idaho. 

The Cassidy-Crapo legislation would have the Department of Health and Human Services deposit money into Health Savings Accounts for people enrolled in bronze or catastrophic health insurance plans purchased on the ACA marketplace in 2026 or 2027, according to a summary of the bill. 

Health Savings Accounts are tax-advantaged savings accounts that consumers can use to pay for medical expenses that are not otherwise reimbursed. They are not health insurance products.

ACA marketplace enrollees who select a bronze or catastrophic plan and make up to 700% of the federal poverty level would receive $1,000 annually if they are between the ages of 18 and 49 and $1,500 per year if they are between the ages of 50 and 64. 

That would set a threshold of $109,550 in annual income for one person, or $225,050 for a family of four, according to the 2025 federal poverty guidelines. The numbers are somewhat higher for residents of Alaska and Hawaii.  

The funding could not go toward abortion access or gender transitions, according to the Republican bill summary. 

Proposal modeled on Trump comments

Cassidy and Crapo outlined how their proposal would work during afternoon floor speeches, where they also aired their grievances with how the Affordable Care Act has affected Americans’ health care costs. 

Crapo rebuked Democrats for establishing the enhanced ACA marketplace tax credits during the coronavirus pandemic and scheduling them to sunset at the end of this year. 

“The pattern has become clear: Democrats respond to rising premiums by throwing taxpayer dollars at the problem,” Crapo said. “Their supposedly short-term fixes only drive premiums higher and make the problem harder to solve. Leaving us with apparently no choice other than to do the same thing again and again and again.”

The GOP plan, he said, was modeled off President Donald Trump’s request to send funding directly to Americans to spend on their health care. 

“Families can use that money to cover costs not handled by their insurance policy without having to wait for insurance companies to approve their treatment decisions,” Crapo said. “Because families want the best value for their money, they will seek out the most appropriate treatment. Over time this will result in lower health care costs as providers compete for patients.”

Cassidy said the bill would not subsidize health insurance premiums but would help some Americans pay for doctor exams, dentist visits, glasses and prescriptions. 

Once eligible ACA marketplace enrollees receive that funding in their Health Savings Accounts, he said, they will shop around for better prices, including on x-rays, which are often used to determine if someone has broken a bone. 

“She’s going to say, ‘Wait a second, the x-ray is $150 here and $500 there. I’m going to where it’s cheaper, not more expensive,’” Cassidy said, giving an example. “And I can tell you when that begins to happen, the people who are more expensive begin to lower their price.”