In a dramatic display of party division and legislative brinkmanship, the U.S. House of Representatives on December 17, 2025, narrowly passed a Republican health care package that notably omits an extension of the expiring Affordable Care Act (ACA) subsidies—tax credits that help millions of Americans afford health insurance. The 216-211 vote, reported by ABC News and CBS News, now sends the bill to the Senate, where its future remains uncertain and the stakes for American families could hardly be higher.
The measure, formally titled the Lower Health Care Premiums for All Americans Act, was unveiled by GOP leaders just days before the vote. According to CBS News, the bill aims to expand association health plans, lower premiums for some ACA enrollees, and enact reforms intended to decrease drug costs. However, it does not address the looming expiration of premium tax credits that have been a lifeline for many who purchase insurance through the ACA marketplace. This omission quickly became the flashpoint for a revolt among moderate Republicans, who warned that allowing the subsidies to lapse on January 1 would drive up premiums for millions and hand Democrats a potent political weapon ahead of next year’s midterm elections.
Despite their objections, four GOP moderates—Brian Fitzpatrick of Pennsylvania, Mike Lawler of New York, Rob Bresnahan of Pennsylvania, and Ryan Mackenzie of Pennsylvania—ultimately voted for the Republican bill. But, in a rare and pointed rebuke to their own leadership, they also joined Democrats in signing a discharge petition to force a separate vote on a three-year extension of the ACA subsidies. As reported by The Washington Post, this maneuver reached the required 218 signatures on December 17, marking a significant, if temporary, victory for those seeking to keep the subsidies alive.
House Speaker Mike Johnson, facing questions about his grip on a fractious caucus, rejected any suggestion that he had lost control. "We have the smallest majority in U.S. history, OK? These are not normal times," Johnson told reporters, as quoted by ABC News. He acknowledged the difficulties of governing with a razor-thin margin, noting that "all the procedures in the book people think are on the table, and that's the difference." Johnson described ongoing talks with moderates as "some intense fellowship," insisting that the party was "working through very complex issues" and keeping "the productive conversation going."
Yet, beneath the surface, tensions were palpable. The House Rules Committee, controlled by Republicans, had blocked last-minute efforts by moderates to attach an ACA subsidy extension to the health care bill, effectively shutting down any chance for compromise before the end of the year. This led Fitzpatrick to urge leadership to "let the House work its will," arguing, "You cannot not put bills on the floor because you're afraid they're going to pass. That's not how this place should operate." Lawler, equally frustrated, told CBS News, "We are fighting tooth and nail to get a vote on an extension. If we can get a vote this week, that's what we're fighting for. It's what we want before we go home."
The discharge petition, a rarely used legislative tool, allows a majority of House members to force a bill to the floor over the objections of leadership. With 218 signatures now secured, the measure to extend ACA subsidies must wait seven legislative days before it can be brought up for a vote—meaning action is delayed until at least January 2026. By then, the subsidies will have expired, and millions of Americans are expected to see sharp increases in their health insurance premiums.
Democratic leaders seized on the moment to criticize Republican leadership. House Minority Leader Hakeem Jeffries called on Johnson to put the three-year extension on the floor "immediately," while Senate Minority Leader Chuck Schumer declared on the Senate floor, "It shows that the demand by the American people for Congress — the House and the Senate — to extend the ACA premium tax credits is undeniable." Schumer warned, "Republicans have made it impossible to prevent many Americans from paying more on their monthly premiums on Jan. 1. And Republicans can't even say they tried to stop it."
For their part, the moderate Republicans who signed the petition made clear their actions were motivated by the needs of their constituents, not by party politics. Bresnahan stated, "Doing nothing was not an option, and although this is not a bill I ever intended to support, it is the only option remaining." Fitzpatrick, reflecting on the imperfect nature of the system, said, "I think the only thing worse than a clean extension, without any income limits and any reforms—because it's not a perfect system—the only thing worse than that would be expiration, and I would make that decision." Lawler, while not endorsing the Democrats' bill, explained, "When leadership blocks action entirely, Congress has a responsibility to act. My priority is ensuring Hudson Valley families aren't caught in the gridlock."
The political ramifications of the standoff are significant. The Congressional Budget Office estimates that an average of 100,000 fewer people per year from 2027 to 2035 would have health insurance under the GOP plan, largely due to the reduction in premium tax credits. The bill would lower gross benchmark premiums by 11% on average through 2035 and reduce the deficit by $35.6 billion, but at the cost of coverage for many, according to the CBO report cited by CBS News.
Meanwhile, the Senate’s response remains a question mark. Although several Republican senators crossed the aisle to support a clean three-year extension of the ACA subsidies in recent votes, the upper chamber as a whole rejected the measure. Senate Majority Leader John Thune has been noncommittal on whether the Senate would take up the issue if it passes the House, telling reporters, "We'll see. We obviously will cross that bridge when we come to it."
The drama is unfolding against the backdrop of a Congress marked by deep polarization and procedural gamesmanship. Lawler, despite his frustration, dismissed the idea of ousting Speaker Johnson, calling such a move "idiotic" and "foolish." He emphasized the need for direct problem-solving rather than constant leadership challenges. Other lawmakers, like Sen. Lisa Murkowski, see the discharge petition as a sign of momentum for bipartisan solutions, noting, "They’re feeling the heat from constituents back home. So at some point in time, you just can't sit there and listen to your leadership say, 'we're not going to do anything.'"
As the House adjourns for the holidays, the fate of ACA subsidies—and the health care costs of millions—hangs in the balance. Lawmakers are set to return in January, when the promised vote on the extension will finally occur. For now, Americans who rely on these subsidies are left in limbo, watching as political maneuvering in Washington threatens to upend their coverage and financial security.
