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A major U.S. federal healthcare subsidy expanded during the COVID-19 pandemic is set to expire at the end of the year after the House of Representatives narrowly advanced a Republican healthcare bill that does not renew the Affordable Care Act (ACA) tax credits. The legislation passed in a 216–211 vote, widely viewed as Congress’s final healthcare vote of the year, and signals that millions of Americans may soon face higher health insurance costs.
The vote followed intense political tension in the House, where Republican leaders confronted internal opposition from members who supported a Democratic-backed extension of the ACA subsidies. Earlier in the day, the House passed a procedural vote, 204–203, blocking Democrats—joined by four Republicans—from forcing immediate votes on a proposed three-year extension of the Obamacare subsidy. Democrats protested loudly, accusing Republican leadership of ending the vote prematurely while members were still attempting to cast ballots.
House Speaker Mike Johnson stated that while Democrats are entitled under House rules to demand a vote on the extension, he would delay it until Congress reconvenes in January. Johnson also made clear his opposition, calling the enhanced ACA subsidies “not good policy.”
If Congress fails to act before year’s end, some of the estimated 24 million Americans who purchase health insurance through the ACA marketplace could see significant premium increases starting January 1. Senate Democrats warned that the lapse could result in millions losing coverage or being forced into plans with higher deductibles and copays.
The Republican healthcare bill aims to lower premiums for certain groups while reducing overall subsidies and raising costs for others beginning in 2027. It also seeks to expand access to association health plans, allowing small businesses and freelancers to buy coverage collectively. Supporters argue the bill reduces federal spending, while critics say it prioritizes budget savings over coverage.
According to the Congressional Budget Office, the bill would reduce the number of insured Americans by about 100,000 annually through 2035 while cutting federal deficits by $35.6 billion. Although the House passed the bill, the Senate is unlikely to consider it before the holiday recess, leaving the future of ACA subsidies uncertain and healthcare affordability a central issue heading into 2026 elections.
