Seventeen Republicans broke with leadership to help constituents. Leadership called it “premature.”
The House voted 230-196 Thursday to extend Affordable Care Act subsidies for three years, with 17 Republicans joining all Democrats in what leaders on both sides described as a significant development in the ongoing debate over whether Americans should be able to afford medical care.
The subsidies, which expired December 31, had helped approximately 22 million Americans pay for health insurance. Without them, premiums are projected to double for most enrollees in 2026.
“Only 7% of the population relies on Obamacare marketplace plans,” said Rep. Jason Smith, the Republican chairman of the House Ways and Means Committee, explaining why the chamber should focus elsewhere. “This chamber should be about helping 100% of Americans.”
He did not specify which legislation would help the remaining 93%.
The 17 Who Defected
The Republicans who broke ranks largely represent swing districts where, sources confirmed, constituents have expressed preferences for affording their medications. Several acknowledged that health care could become “a political vulnerability” in the 2026 midterms if premiums continued rising.
“Healthcare affordability is not a political issue; it is a governing responsibility,” said Rep. Mike Lawler (R-NY) in a statement, drawing a distinction some colleagues found unclear.
Rep. María Elvira Salazar (R-FL), whose district has one of the highest ACA enrollment rates in the country, said she “didn’t hesitate” to vote yes. Her office noted that many of her constituents depend on the assistance “to afford care,” a framing that leadership suggested was beside the point.
Senate Signals Resistance
Senate Majority Leader John Thune said Thursday there is “no appetite” in the upper chamber for extending the subsidies as written, though he indicated openness to a compromise that includes “reforms.”
Asked what reforms would make helping people afford insurance more palatable, Thune said the aid should be “focused on those who most need the help” and that beneficiaries should “at least pay a nominal amount for their coverage.”
The current subsidies are already means-tested and require beneficiaries to pay premiums. Thune’s office did not respond to questions about whether he was aware of this.
A bipartisan group of senators is negotiating a compromise that could include directing funds to health savings accounts, which would allow Americans to save money they do not have for medical expenses they cannot predict.
Hyde Amendment Complications
Negotiations have stalled partly over the Hyde Amendment, which already prohibits federal funding for most abortions but which some Republicans want strengthened before agreeing to help people afford checkups.
President Trump told Republicans to be “flexible” on Hyde, prompting pushback from conservatives who said flexibility on abortion restrictions was a prerequisite they had not previously mentioned for addressing premium increases.
“We don’t do federal funding for abortions,” said Sen. Bernie Moreno (R-OH). “That’s a long-standing tradition, nobody’s looking to change that.”
He then returned to discussing whether the abortion language was sufficient to permit a vote on insurance subsidies.
The Congressional Budget Office estimates the extension would cost $80 billion over a decade while insuring 4 million additional Americans. Lawmakers are weighing whether those numbers represent good value.
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