On December 17, 2025, the U.S. House of Representatives set the stage for a dramatic shift in American health care by passing a Republican health care bill that does not renew the enhanced Affordable Care Act (ACA) premium tax credits, just weeks before these subsidies are set to expire. The 216-211 vote, largely along party lines, signals a period of uncertainty for millions of Americans who rely on these subsidies to keep their insurance affordable.
The bill, titled the “Lower Health Care Premiums for All Americans Act,” was championed by House Republicans as a comprehensive alternative to simply extending the ACA subsidies. According to The Plain Dealer, the legislation would fund cost-sharing reduction payments starting in 2027, expand association health plans for small businesses, increase transparency for pharmacy benefit managers, and codify rules for health reimbursement arrangements. However, it notably excludes any extension of the enhanced premium tax credits that were expanded during the COVID-19 pandemic and are due to lapse on December 31, 2025.
As the deadline looms, the consequences of inaction are coming into sharp focus. The Congressional Budget Office (CBO) estimates that if the subsidies expire, the average annual premium for subsidized enrollees will jump from $888 to $1,904 in 2026—a staggering 114% increase. The CBO further projects that 2.2 million people will lose insurance in 2026, with that number rising to 3.8 million annually through 2034. In Ohio alone, approximately 583,000 residents are expected to be affected by the expiration, as reported by The Plain Dealer.
The political drama played out against a backdrop of deep division. Four moderate House Republicans—Brian Fitzpatrick (Pennsylvania), Mike Lawler (New York), Rob Bresnahan (Pennsylvania), and Ryan Mackenzie (New York)—broke with party leadership and joined Democrats in signing a discharge petition to force a vote on a three-year clean extension of the enhanced subsidies. However, due to House procedural rules, that petition cannot be acted upon until Congress returns from its holiday break in January 2026, meaning the subsidies will expire before any new vote can occur. As Axios noted, this delay leaves millions in limbo, facing the prospect of sharply higher premiums or loss of coverage.
The Republican leadership’s rationale for opposing an extension was summed up by Speaker Mike Johnson, who argued, “A subsidy extension only hides the true cost of the failed law.” GOP leaders have insisted that extending the enhanced ACA subsidies would be wasteful spending that primarily benefits insurance companies. Instead, they touted their bill’s measures as ways to lower health care costs for a broader swath of Americans, not just those on the ACA exchanges. The House bill, according to Axios, would expand association health plans, impose new transparency requirements on pharmacy benefit managers aimed at lowering drug costs, and fund ACA payments known as cost-sharing reductions.
But critics, including Democrats and some moderate Republicans, counter that the bill fails to address the most urgent issue: the looming expiration of the subsidies. Representative Emilia Sykes, a Democrat from Akron, warned that the end of the subsidies would cause “22 million Americans’ health care premiums to double, triple or quadruple, costing them hundreds of additional dollars a month, and more than 4 million Americans will lose their coverage entirely.” She shared stories from constituents who are already anxious about how they will afford care in the new year, saying, “It is unacceptable that Congress is about to head home having done nothing, nothing to protect the millions of Americans who will lose coverage on January 1.”
Even some Republicans voiced concerns about the political fallout. Moderate GOP Representative Kevin Kiley (California) admitted the bill is “fine” but “pretty narrow” and “hastily thrown together,” adding, “It doesn’t actually address the issue that’s right in front of us which is that these tax credits are going to go away.” According to Axios, moderates facing tough re-election battles in 2026 are worried about the impact of spiking premiums on their constituents and their own political futures.
For many Americans, the practical implications of the vote are daunting. If the subsidies are allowed to expire, millions could see their health insurance premiums more than double. Middle-income families, in particular, may find themselves squeezed out—earning too much to qualify for Medicaid but unable to afford full-priced insurance. Older adults and those in high-cost states are expected to be hit hardest, with some forced to downgrade or drop their coverage altogether. Hospitals, rural providers, and community health centers could see a spike in uncompensated care, further straining the health system and exacerbating disparities in access and outcomes, as reported by The American Journal of Managed Care® (AJMC®).
Employers, too, are bracing for change. With traditional group plan renewals increasing by as much as 20%, 25%, 40%, or even 50%, many are exploring alternatives like Individual Coverage Health Reimbursement Arrangements (ICHRAs). Ben Light, VP of partnerships at Zorro and an expert in ICHRAs, told AJMC®, “We see a lot of companies that are exploring the ICHRA because they’ve gotten a 20%, 25%, 40%, or 50% renewal on their traditional group plan. I think you’re going to have people looking at the ICHRA because it’s a shift of risk, and you’re moving that risk from the population, just in your company now, out to the individual market.”
Meanwhile, the Senate remains at an impasse. Earlier in December, both Democratic and Republican health care plans failed to advance, each falling short of the 60 votes needed for passage. Two Ohio senators, Bernie Moreno and Jon Husted, have introduced competing proposals to address the subsidy expiration. Moreno’s bill, the Consumer Affordability and Responsibility Enhancement (CARE) Act, would extend the enhanced tax credits for two years but cap eligibility at $200,000 in household income and require a minimum $25 monthly premium. Husted’s Accountability for Better Care Act would also extend the credits for two years, set a $5 minimum monthly premium, restrict eligibility to U.S. citizens, and fund cost-sharing reductions starting in 2027. Both bills face uncertain prospects in a divided Senate.
The House GOP bill also includes abortion coverage restrictions, prohibiting cost-sharing reduction payments to plans that cover abortion except in cases of rape, incest, or to save the mother’s life. This provision has drawn criticism from Democrats, who argue it sets the stage for a national abortion ban.
With just days remaining before the subsidies expire, millions of Americans, as well as employers and health care providers, are left in a state of anxious anticipation. The political battle over the future of health care affordability is far from over, and the choices Congress makes in the coming weeks will have profound consequences for the nation’s health and economic well-being.
As the clock ticks toward the new year, the fate of the ACA subsidies—and the financial security of millions—hangs in the balance, awaiting the next move from a deeply divided Congress.
