WASHINGTON — In a rare and striking act of legislative defiance, the U.S. House of Representatives voted 230–196 on Thursday to pass H.R. 1834, a bill designed to reinstate enhanced health care subsidies that expired at the start of 2026. The move saw 17 Republicans break ranks with House Speaker Mike Johnson to join a unified Democratic caucus, successfully bypassing leadership through a discharge petition to address what many are calling a burgeoning national health care crisis.
The subsidies in question—known as Enhanced Premium Tax Credits (EPTC)—were first introduced during the pandemic and later extended through 2025. Their expiration on December 31, 2025, has already had a seismic impact on the insurance market. According to recent data from the Kaiser Family Foundation (KFF), approximately 20 million Americans saw their monthly premiums skyrocket this month, with some families facing cost increases of over 114%. In states like Texas and New Jersey, officials warned that without federal intervention, uninsured rates could climb back to historic highs.
A Rare Procedural Victory
The bill’s passage marks a significant moment for the 119th Congress. Because Republican leadership had initially refused to bring the extension to the floor, proponents utilized a discharge petition—a procedural tool requiring 218 signatures to force a vote.
“Today, we chose the health of our constituents over party dictates,” said one of the moderate Republicans who supported the measure. Democratic leaders echoed this sentiment, with Representative Lizzie Fletcher (D-TX) stating that failing to extend these credits would lead to “the largest loss of health care in American history.”
The Road Ahead in the Senate
While the House victory provides hope for those currently struggling with 2026 premiums, the bill faces a steep climb in the Republican-controlled Senate. Majority Leader John Thune (R-SD) has indicated that any final agreement must include GOP priorities, such as:
- Income caps to limit eligibility for higher earners.
- Minimum out-of-pocket premiums (roughly $5/month) to ensure “skin in the game.”
- Expansion of Health Savings Accounts (HSAs), a priority championed by President Trump.
Despite these hurdles, a bipartisan group of senators, including Susan Collins (R-ME) and Jeanne Shaheen (D-NH), are reportedly nearing a compromise that could see the subsidies restored for two years rather than three, potentially involving a model where funds are deposited directly into patient-controlled accounts.
Economic and Social Impact
The Congressional Budget Office (CBO) estimates that a three-year extension would increase the federal deficit by roughly $80.6 billion over a decade. However, advocates argue the cost is justified; the CBO also projects the bill would prevent nearly 4 million people from losing their health coverage by 2028. For now, millions of Americans remain in a state of financial limbo, waiting to see if the Senate will follow the House’s lead before the current open enrollment window closes on January 15.
Sources
- The Guardian: US House breaks with Trump to revive Affordable Care Act subsidies
- PBS News: House passes bill to extend health care subsidies in defiance of GOP leaders
- Congresswoman Nellie Pou (Press Release): Congressman Pou Votes to Reinstate the ACA Tax Subsidies
- AJMC: House Votes to Extend ACA Subsidies, Eyes Turn to Senate
- Mother Jones: House Passes Three-Year ACA Extension
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