US House backs extension of health insurance subsidies after Dems force vote

WASHINGTON — The U.S. House approved a bipartisan bill Thursday to resurrect the enhanced tax credits that expired at the end of last year for people who purchase their health insurance from the Affordable Care Act marketplace.

The 230-196 vote sends the legislation to the Senate, where Republican leadership is unlikely to put it on the floor without considerable changes, which a bipartisan group of senators appears close to finalizing. Seventeen Republicans voted with every Democrat to pass the bill. Rep. Nick Begich III, R-Alaska, voted against reviving the enhanced tax credits for people who purchase their health insurance from the Affordable Care Act marketplace.

House GOP leaders didn't want to bring the bill up in their chamber, but a handful of their own members signed a discharge petition in December, forcing the vote amid rising health care costs.

Massachusetts Democratic Rep. Jim McGovern said during floor debate on Wednesday evening "it's about damn time" the chamber took up a bill to address the now-expired tax credits, arguing lawmakers have a "moral obligation to act" to help people afford health insurance.

"This Congress musters up the will to spend trillions of dollars on tax breaks for billionaires and to send the Pentagon billions of dollars more than they even asked for. And the administration came up with tens of billions of dollars to bail out Argentina, for God's sake," McGovern said. "But somehow helping moms and dads, grandparents and kids afford trips to the doctor is a step too far for this Republican leadership."

New York GOP Rep. Mike Lawler said he only backed the bill after Republican leaders declined to bring up a bipartisan two-year compromise bill he helped negotiate last year.

"I am voting in favor of this discharge and of this legislation to send it to the Senate so that the Senate will have the opportunity to put forth a reform package that can pass Congress and become law," Lawler said.

Republicans and Democrats, he said, agree that the country's health care system is in need of a serious overhaul. He called on his colleagues to find solutions to the bigger, more structural issues.

"Enough of the blame game on both sides," Lawler said. "Let's focus on actually delivering affordable health care for Americans."

Prolonged fight over ACA tax credits

Democrats originally established the enhanced ACA marketplace tax credits during the coronavirus pandemic in an attempt to get more people health insurance coverage. They set the subsidies to expire at the end of 2025.

The debate over the sunset date simmered in the background for much of last year but surged to the forefront in October after Democrats shut down the government and repeatedly demanded GOP leaders negotiate an extension to the expiring enhanced tax credits.

The shutdown ended in mid-November after Senate Majority Leader John Thune, R-S.D., agreed to give Democrats a vote on a health care bill of their choosing in December.

Senate Minority Leader Chuck Schumer, D-N.Y., ultimately decided to bring up a three-year extension of the enhanced tax credits without any changes, but it failed to get the 60 votes needed to advance.

A proposal from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo, both Republicans, that would have provided funding through Health Savings Accounts for some ACA marketplace enrollees during 2026 and 2027 also failed to move toward final passage.

A House Republican health care bill passed that chamber last month, but doesn't have the bipartisan support to move through the Senate and become law.

Senate problems

Thune said Tuesday any renewal of the enhanced ACA marketplace subsidies would need reforms to move through that chamber.

The bill, he said, would need to set income limits on who qualifies for the enhanced tax credit and eliminate ACA health insurance plans that have $0 premiums, a feature Republicans allege allowed insurance companies to enroll people without their knowledge to receive the subsidy.

"And then the second component would be some sort of a bridge to (Health Savings Accounts). An expansion of HSAs so that you're getting more money into the pockets of the American people, the patients, if you will, the consumers, as opposed to insurance companies," Thune said. "And then finally you've got to deal with the Hyde issue."

The Hyde Amendment has been a feature of government spending bills for decades, preventing federal dollars from going to abortions unless the pregnancy is the result of rape, or incest, or threatens the woman's life.

Republicans want the prohibition to apply to all ACA marketplace health insurance plans without any way for Americans to pay for the coverage themselves, the way they do now. Democrats have rejected the change as a non-starter that would restrict abortion access in blue states.

'Be a little flexible on Hyde,' says Trump

President Donald Trump waded into that debate this week, telling House Republicans during a policy retreat at the Kennedy Center they must be "flexible" about the Hyde Amendment in order to broker a health care deal that can reach his desk.

"You have to be a little flexible on Hyde. You know that. You've got to be a little flexible," Trump said. "You've got to work something. You've got to use ingenuity. You've got to work. We're all big fans of everything, but you've got to have flexibility."

Susan B. Anthony Pro-Life America President Marjorie Dannenfelser rebuked Trump for the comment, writing in a statement that to "suggest Republicans should be 'flexible' is an abandonment of this decades-long commitment. If Republicans abandon Hyde, they are sure to lose this November."

States have a patchwork of laws addressing abortion coverage in ACA marketplace health insurance plans, with 25 prohibiting coverage with certain exceptions and 12 requiring abortion coverage, according to analysis from the nonpartisan health research organization KFF.

"In states that do not bar coverage of abortions on plans available through the Marketplace, insurers may offer a plan that covers abortions beyond the permissible Hyde amendment situations when the pregnancy is a result of rape, or incest or the pregnant person's life is endangered, but this coverage cannot be paid with federal dollars."

Any ACA marketplace health insurance plan that offers abortion coverage in circumstances outside those three exceptions must charge each enrollee $1 for that coverage, according to KFF.

Behind the scenes in the Senate

A bipartisan group of senators has been talking behind the scenes for months about how to extend the ACA marketplace subsidies with changes.

Ohio Republican Sen. Bernie Moreno said Thursday he expects the group, which has agreed on a "framework," to release a bill next week, though he cautioned that's just one small step.

"We have agreement that we think we have a skeleton of a deal. But it's all fun and games until you have it on paper in a bill form," Moreno said. "So we have to do that. And then we have to go sell the heck out of it to our conference. And again, look, this is politics. There's people on both sides that want this to fail. So we have to get past that massive mountain."

Ohio Republican U.S. Sen. Bernie Moreno speaks with reporters in the Capitol building in Washington, D.C., on Thursday, Jan. 8, 2026. (Photo by Jennifer Shutt/States Newsroom)

Moreno said the tentative plan is to revive the enhanced ACA marketplace tax credit for another two years with modifications.

The bill would also:

Extend open enrollment for this year until March 1.

Cap the enhanced subsidy for people making under 700% of the federal poverty level, or about $109,550 in annual income for one person, according to the guidelines for 2025.

Require people eligible for the enhanced tax credit to pay at least $5 per month or $60 per year for their health insurance to ensure the enrollee knows about their coverage.

Fine insurance companies $1,000 for "deliberately causing fraud, meaning signing someone up without their consent."

ACA marketplace enrollees eligible for the enhanced tax credit would have a choice in 2027 to either keep the lower premium that stems from the health insurance company receiving the subsidy, or move to a Health Savings Account where they would receive the money from the government.

"The final piece, which I think is the biggest sweetener to the whole deal, is putting back in place cost-sharing reduction payments, which, according to (the Congressional Budget Office), reduce premiums for everybody in the exchange by 11% and save the federal government money," Moreno said, later clarifying that would happen in 2027.

There is not yet a final proposal regarding how ACA marketplace plans handle abortion coverage in states where it's allowed, he said.

The handshake agreement, Moreno said, is intended to give Congress time to overhaul the bigger issues facing the country's health insurance and health care systems in a way that reduces costs.

Gang of negotiators

Moreno said the core group of negotiators, which he nicknamed the EPTCOG gang on his text chain, includes six Democrats and five of his Republican Senate colleagues. There are 24 senators total in the "extended OG" gang.

Moreno believes one of his advantages in the negotiations is that he hasn't been around the Senate that long, having just been elected in 2024. He said senators are also handling the details themselves, instead of deferring much of the work to staff.

"This has been principals only. We don't even allow staff in meetings," Moreno said. "And the idea is if we can't work it out, there's really no point in tasking this with staff."

New Hampshire Democratic Sen. Jeanne Shaheen, one of the negotiators, said Wednesday she wasn't aware of a deadline for the negotiators to release a bill. She also brushed aside the possibility of changes to how the ACA handles abortion coverage.

"There is no need to come to a compromise because it's already been dealt with in the Affordable Care Act," Shaheen said. "There is very specific language on how it is dealt with. And I think that applies to whatever happens with the Affordable Care Act."

Shaheen said Thursday the House vote "provides momentum" for Senate negotiators.