WASHINGTON (AP) — Asked why Republicans are not moving to extend federal health care subsidies, Speaker Mike Johnson has a ready theory: Their party wants to help 100% of Americans pay, not just the 7% who enroll in Affordable Care Act plans.
But not 100% of people in the meeting agreed.
A rare revolt by party moderates disrupted Johnson’s plans. This week, four Republicans signed a Democratic relief petition guaranteeing that the House will vote on extending ACA subsidies sometime in January, with Republican leaders now powerless to stop it.
For Democrats, it’s vindication of a months-long strategy that began with the government shutdown in the fall to push the expiration of ACA support to the forefront of politics. Republicans from competitive districts most likely to lose seats in next year’s midterm elections feel the political pressure as they hear from voters that their premiums are soaring.
“There are no changes in House Republican leadership, but there are some changes within their own ranks,” said Rep. Pete Aguilar, chairman of the House Democratic Caucus.
House Democratic Leader Hakeem Jeffries, accompanied by caucuses on the steps of the Capitol on Thursday, asked Johnson to allow a vote on a three-year extension of Affordable Care Act (ACA) subsidies before lawmakers go on vacation: “Not tomorrow, not next week, not next year. Not today.”
Johnson declined, saying “it will be on the floor the first week of January when we come back.”
Lawmakers prepare to leave undecided place
The impasse has left lawmakers in suspense as they head home for the holidays. Republican leaders are now under increasing pressure to appease centrist members who have threatened to back Democrats in approving a three-year extension of Affordable Care Act subsidies.
Senate Majority Leader John Thune must face this issue as well. Any Affordable Care Act bill that passes 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 impose new limits on them. But they won’t consider anything until January.
Thune told reporters Thursday that “a failed program filled with fraud, waste and abuse will not be extended for three years.”
However, Republican leaders in the House and Senate have yet to come up with a plan that would fully address lawmakers’ concerns about the steep increases in insurance costs that many Americans are expected to face in 2026 and beyond.
A senior administration official involved in the negotiations said the White House has been involved in discussions about the health care proposal but has largely allowed House Republicans to resolve internal differences and coalesce around a plan on their own. The official spoke on condition of anonymity to discuss private discussions.
House Republicans on Wednesday passed a more than 100-page health care plan that focuses on long-standing Republican priorities, including expanding coverage for small businesses and the self-employed. The bill would also restrict pharmacy benefit managers — the middlemen who manage drug costs and process insurance claims.
Johnson praised the measure as “a bigger, better, more important thing for 100 percent of Americans, not just 7 percent of Americans.” But some Republicans facing tough re-election campaigns remain concerned about the looming spike in the Affordable Care Act’s costs.
The holidays provide Johnson a brief window to try to persuade moderates to abandon the effort. Release petitions are frozen once they reach the 218-signature threshold, meaning that while only four Republicans have signed publicly, there may be more willing to support the Democratic bill.
Rep. Ryan Mackenzie, one of four Republicans who signed the Democratic petition, said the petition “sparks more conversation” and “hopefully over the next three weeks we’ll actually see some changes in bipartisan efforts that can actually produce meaningful votes, 218 votes in the House and 60 votes in the Senate.”
“I think it’s critical that voting be allowed,” McKenzie said. “I think everyone should be able to vote on the board, and they should be able to let everyone in the American public see how they vote on these individual issues.”
Leader Jeffries’ waiting game pays off
For months, Jeffries refused to support a one-year extension of Affordable Care Act subsidies that a bipartisan group of lawmakers had been seeking, calling it “a nonstarter” and “a laughable proposal.”
Instead, he insisted on a three-year extension with no revenue cap or cost offsets. The strategy paid off, and when Johnson refused to hold any vote on an extension of the Affordable Care Act, Republican moderates were forced to move in his direction.
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 the Republican Party. But much of his party rallied in support of him on the Capitol steps Thursday, with several lawmakers praising his approach.
“As Leader Jeffries has said all along, this is the only real plan on the table,” Aguilar said.
Still, insurance costs are expected to rise for millions of people next year, and even if a three-year extension of Affordable Care Act subsidies passes the House, the chances of passage are slim, even as Democrats have secured the vote. Senate Republicans have rejected a three-year extension, but some GOP senators open to a subsidy deal said a House vote could provide momentum.
“We can have a vehicle — if we can get support from Republicans and Democrats — then we can bring it back,” Republican Sen. Thom Tillis said, adding that “means there’s still a chance.”
For Democrats, the fight also allows them to unite around a message they think could be effective on the campaign trail.
“The Republican health care crisis is unacceptable, unconscionable and un-American,” Jeffries said.
Republican House split
The decision by four Republicans to break with their party leadership and join Democrats is just the latest sign of discontent in the narrowly divided House.
Johnson argued that criticism of his leadership — and lawmakers’ repeated bypasses to force votes — was inevitable given the slim Republican majority. He said he lacked the advantage of the majority and “the speaker has a long stick and he will impose punishment”.
“I don’t because our margins are small,” he said. Regarding the extension of the Affordable Care Act, Johnson said leadership had “discussed at length” with Republican moderates and described those conversations as “some intense friendships.”
“Everyone is in good spirits now and everyone understands what’s going on,” he added.
However, some Republican members seemed to disagree with that assessment. As lawmakers returned home for the holidays, discontent lingered.
“I don’t know why we didn’t get a vote on a good bipartisan extension deal,” said Republican Rep. Don Bacon, adding that Democrats would use the health care issue “like a sledgehammer” on the campaign trail.
House Majority Leader Steve Scalise, R-Louisiana, insisted Republicans would finish the year “as united as ever.”
“The approach we’ve set is to do big things, not small things, and that means we’re going to have some differences along the way.”
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Associated Press writers Mary Claire Jalonick and Kevin Freking contributed to this report.
