Speaker Mike Johnson had a ready-made refrain when asked why Republicans weren’t moving to extend federal health care subsidies: their party wanted to help 100% of Americans with their costs, not just the 7% of Americans enrolled in Affordable Care Act plans.
But not 100% of his conference agreed.
A rare revolt from the moderate wing of the party has upended Johnson’s plans. Four Republicans this week signed onto a Democratic discharge petition that guarantees that the House will vote on extending the ACA subsidies sometime in January, with Republican leaders now powerless to stop it.
For Democrats, it was vindication of a months-long strategy, starting with the government shutdown in the fall, that pushed the expiration of the ACA support to the forefront of politics. Republicans from competitive districts most at risk of losing their seats in next year’s midterms felt the political pressure as they heard from constituents about their skyrocketing premiums.
“Nothing has changed with House Republican leadership, but something has changed within their own ranks,” said Rep. Pete Aguilar, chair of the House Democratic Caucus.
Flanked by his caucus Thursday on the Capitol steps, House Democratic Leader Hakeem Jeffries demanded that Johnson allow a vote on the three-year extension of ACA subsidies before lawmakers leave for the holidays: “Not tomorrow. Not next week. Not next year. Today.”
Johnson refused, saying it will “be on the floor that first week of January when we return.”
Lawmakers prepare to leave in limbo
The impasse left lawmakers with a cliffhanger as they headed home for the holiday break. Republican leaders now face growing pressure to appease centrist members who are threatening to side with Democrats to approve an extension of Affordable Care Act subsidies for three years.
Senate Majority Leader John Thune has to confront the issue as well. Any ACA bill clearing the House would simply push the fight to the Senate, which has already rejected a three-year extension.
A bipartisan group of senators has been meeting and discussing possible compromise bills that would extend the subsidies but put new limitations on them. But they would not consider anything until January.
Thune told reporters Thursday that a three-year extension of “a failed program that’s rife with fraud, waste and abuse is not happening.”
Yet Republican leaders in both chambers have not offered a plan that fully addresses members’ concerns about the sharp insurance cost increases many Americans are expected to face in 2026 and potentially beyond.
The White House has been engaged in discussions about the healthcare proposals but has largely allowed House Republicans to sort out their internal divisions and coalesce around a plan on their own, according to a senior administration official involved in the talks who was granted anonymity to discuss private discussions.
House Republicans on Wednesday passed a 100-plus-page health care package centered on long-standing GOP priorities, including expanding coverage options for small businesses and the self-employed. The bill would also rein in pharmacy benefit managers — middlemen that manage drug costs and process insurance claims.
Johnson touted the measure as “a bigger and better and more important thing for 100% of Americans, not just 7% of Americans.” But some Republicans who face tough reelection bids remain fixated on the looming spike in ACA costs.
The holidays provide Johnson with a brief window to try to persuade moderates to abandon the effort. The discharge petition froze once it reached the 218-signature threshold, meaning that while only four Republicans have publicly signed on, more may be willing to support the Democratic bill.
Rep. Ryan Mackenzie, one of the four Republicans who signed the Democratic petition, said it has “generated more conversations” and that “hopefully over the next three weeks, we will actually see some changes in some bipartisan efforts that actually can generate a meaningful vote that gets 218 in the House and 60 in the Senate.”
“I think allowing a vote is critically important,” Mackenzie said. “I think everybody should be able to put up their votes on the board, and they should be able to let everybody in the American public see how they voted on these individual issues.”
Leader Jeffries’ waiting game pays off
For months, Jeffries refused to support a one-year extension of ACA subsidies that a bipartisan group of lawmakers had been pursuing, dismissing it as a “non-starter” and “a laughable proposition.”
Instead, he held firm on a three-year extension with no income caps or cost offsets. That strategy paid off, as GOP moderates were forced to move in his direction when Johnson refused to allow any vote on an ACA extension.
Jeffries has faced criticism this year from progressive members of his caucus and grassroots groups who have urged him to push back more forcefully against Trump and Republicans. But on Thursday, much of the party rallied behind him on the Capitol steps, with several lawmakers praising his approach.
“As Leader Jeffries has said all along, this is the only real plan on the table,” said Aguilar.
Still, while Democrats have secured a vote, insurance costs for millions are set to rise next year, and passage of a three-year ACA subsidies extension remains a long shot even if it does pass the House. Senate Republicans have already rejected the three-year extension, but some GOP senators who are open to a deal on the subsidies said a House vote could provide momentum.
“We could have a vehicle — if we could get Republicans and Democrats behind it — then we could send it back,” said GOP Sen. Thom Tillis, adding that it “means that there’s still a chance.”
For Democrats, the fight has also allowed them to unify around a message they believe could prove potent on the campaign trail.
“The Republican health care crisis is unacceptable, unconscionable, and un-American,” Jeffries said.
A Republican House divided
The decision by four Republicans to break with party leadership and join Democrats is only the latest sign of discontent in the narrowly divided House.
Johnson has argued that the criticism directed at his leadership — and lawmakers repeatedly bypassing leadership to force votes — is inevitable given the slim GOP majority. He said he lacks the advantages of a large majority, where “the speaker had a long stick that he would administer punishment.”
“I don’t have that, because we have a small margin,” he said. Of the ACA extensions, Johnson said leadership had “talked about it at length” with GOP moderates, describing the conversations as “some intense fellowship.”
“Everybody’s in good spirits now and everybody understands what’s happening,” he added.
Some GOP members, however, don’t appear to share that assessment. There was lingering discontent as lawmakers headed home for the holidays.
“I don’t know how we did not vote on a good bipartisan extension,” said GOP Rep. Don Bacon, adding that Democrats will use the health care issue “like a sledgehammer” on the campaign trail.
House Majority Leader Steve Scalise, R-La., insisted that Republicans are finishing the year “as united as we’ve ever been.”
“We set out on a course to do big things, not little things, and that means we’re going to have some differences along the way.”
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Associated Press reporter Mary Clare Jalonick and Kevin Freking contributed to this report.
This story was originally featured on Fortune.com
