House Minority Leader Hakeem Jeffries, D-N.Y., speaks during a press conference at the U.S. Capitol on January 8, 2026, in Washington, DC. Schumer and Jeffries spoke with reporters on topics including upcoming minimum legislation expanding subsidies for health insurance. (Photo: Kevin Dietsch/Getty Images)
WASHINGTON — The U.S. House of Representatives on Thursday approved a bipartisan bill to restore enhanced tax credits that expired at the end of last year for people who buy health insurance through the Affordable Care Act platform.
The 230-196 votes sends the legislation to the Senate, where Republican leaders are unlikely to bring it to a vote without significant changes that a bipartisan group of senators appear close to finalizing. Seventeen Republicans voted in favor of the bill along with every Democrat.
Republican Party leaders in the House of Representatives did not want to introduce the bill to their chamber, but to a handful of their members signed the discharge application in December, forcing the vote in the face of rising health care costs.
Massachusetts Democratic Rep. Jim McGovern said during Wednesday night’s debate that “it’s high time” for the House to pass a bill to address expired tax credits, arguing that lawmakers have a “moral obligation to act” to aid people become health insurance carriers.
“This Congress musters the will to spend trillions of dollars on tax breaks for billionaires and send the Pentagon billions of dollars more than it even asked for. And the administration came up with tens of billions of dollars to bail out Argentina, for God’s sake,” McGovern said. “But somehow helping moms and dads and grandparents and kids pay for doctor visit expenses is a step too far for this Republican leadership.”
New York GOP Rep. Mike Lawler said he would support the bill only after GOP leaders refused to put forward a bipartisan, two-year compromise bill he helped negotiate last year.
“I am voting to grant discharge and to send this legislation to the Senate so that the Senate has the opportunity to put forward a reform package that can be passed by Congress and become law,” Lawler said.
Republicans and Democrats, he said, agree that the nation’s health care system needs a major overhaul. He challenged his colleagues to find solutions to larger, more structural problems.
“Enough of the blame-shifting on both sides,” Lawler said. “Let’s focus on actually providing Americans with affordable health care.”
The protracted fight over ACA tax breaks
Democrats originally enacted enhanced tax credits in the ACA marketplace during the coronavirus pandemic in an attempt to get more people covered by health insurance. They agreed that the subsidies would expire at the end of 2025.
The end-date debate had been simmering in the background for much of last year, but came to the fore in October when Democrats shut down the government and repeatedly demanded that GOP leaders negotiate an extension of expiring enhanced tax credits.
The work stoppage ended in mid-November after Senate Majority Leader John Thune, R-D., agreed to give Democrats a vote on their chosen health care bill in December.
Senate Minority Leader Chuck Schumer, D-N.Y., ultimately decided to propose a three-year extension of the enhanced tax credits without any changes, but failed to obtain the required 60 votes advance.
A proposal by Sen. Bill Cassidy of Louisiana and Idaho Sen. Mike Crapo, both Republicans, that would have provided health savings account funding to some people enrolled in the ACA marketplace in 2026 and 2027 also did not ultimately pass.
House of Representatives health care bill passed this House last monthbut there is no bipartisan support to pass the Senate and become law.
Senate problems
Thune said Tuesday that any renewal of the ACA’s enhanced marketplace subsidies would require reforms to pass the chamber.
He said the bill would have to set income limits for people eligible for the increased tax credit and eliminate ACA health insurance plans that have $0 premiums, which Republicans say would allow health insurance companies to enroll people without their knowledge to receive subsidies.
“And then the second piece would be kind of a bridge to (health savings accounts) HSA expansion, which puts more money in the pockets of Americans, the patients, the consumers, if you will, as opposed to the insurance companies,” Thune said. “And you’ll finally have to deal with the Hyde case.”
The Hyde Amendment has been a part of government spending bills for decades, preventing federal dollars from being used for abortions unless the pregnancy is the result of rape, incest or endangers the woman’s life.
Republicans want the ban to apply to all ACA health insurance plans on the marketplace, so that Americans do not have the option of paying for this coverage on their own, as they do now. Democrats dismissed the change as a nonstarter that would limit abortion access in blue states.
“Be a little flexible with Hyde,” Trump advises
President Donald Trump waded into that debate this week, telling House Republicans at a policy retreat at the Kennedy Center that they needed to be “flexible” on the Hyde Amendment in order to negotiate a health care deal that could reach his desk.
“You’ve got to be a little flexible with Hyde. You know that. You’ve got to be a little flexible,” Trump said. “You’ve got to work at something. You’ve got to be creative. You’ve got to work. We’re all big fans of everything, but you’ve got to be flexible.”
Susan B. Anthony Pro-Life America President Marjorie Dannenfelser blasted Trump for the comment, writing in a statement that “to suggest Republicans should be ‘flexible’ is to abandon this decades-long commitment.” If Republicans abandon Hyde, they will surely lose in November.”
States have a set of laws regarding abortion coverage in ACA health insurance plans, with 25 of them prohibiting coverage with some exceptions and 12 requiring abortion coverage. according to analysis from the impartial research organization KFF.
“In states that do not prohibit abortion coverage in commercially available plans, insurers may offer a plan that covers abortions beyond the permissible situations set forth in the Hyde Amendment when the pregnancy is the result of rape, incest, or the life of the pregnant person is in danger, but this coverage cannot be covered by federal dollars.”
According to KFF, any ACA health insurance plan that provides abortion coverage in circumstances beyond these three exceptions must charge each enrollee a $1 fee for that coverage.
Behind the scenes of the Senate
A bipartisan group of senators has been talking behind the scenes for months about how to expand ACA marketplace subsidies with the changes.
Ohio Republican Sen. Bernie Moreno said Thursday he expected the group that agreed on the “framework” to release a bill next week, though he cautioned it was just one petite step.
“We agree that we have the skeleton of a deal. But it’s all fun and games until you have it on paper in the form of a bill,” Moreno said. “So we have to do it. And then we have to sell it to our conference. And again, look, this is politics. There are people on both sides who want this to fail. So we have to overcome this huge mountain.”
Moreno said the tentative plan is to resume the ACA enhanced marketplace tax credit for another two years with modifications.
The bill would also:
- Registration extension for this year until March 1.
- Limiting the enhanced subsidy to people earning less than 700% of the federal poverty level, or about $109,550 in annual income for one person, according to guidelines for 2025.
- Require people eligible for the increased tax credit to pay at least $5 per month or $60 per year for health insurance to ensure that enrollees know about their coverage.
- It fines insurance companies $1,000 for “intentionally causing fraud, which means signing a contract with someone without their consent.”
People enrolled in the ACA platform and eligible for the increased tax credit will have a choice in 2027: either keep the lower premium resulting from receiving subsidies from the health insurance company, or move to a savings account where they will receive money from the government.
“The final piece, which I think is the biggest sweetener of the whole deal, is the restoration of cost-sharing reduction payments, which the (Congressional Budget Office) says reduces premiums for everyone participating in the exchange by 11% and saves the federal government money,” Moreno said, later explaining that it would happen in 2027.
There is no final proposal yet on how ACA marketplace plans will treat abortion in states where it is allowed, he said.
Moreno said the handshake is intended to give Congress time to review more vital issues facing the nation’s health insurance and health care systems in a cost-containing way.
A gang of negotiators
Moreno said the core group of negotiators, which he referred to in his text chain as the EPTCOG gang, consists of six Democrats and five of his Senate Republican colleagues. There are a total of 24 senators in the “extended OG” gang.
Moreno believes one advantage he has in the negotiations is that he hasn’t been in the Senate as long because he was elected in 2024. He said senators also handle the details themselves, rather than leaving most of the work to staffers.
“It only affected directors. We don’t even allow employees to have meetings,” Moreno said. “The point is, if we can’t handle it, there’s really no point in delegating it to staff.”
New Hampshire Democratic Sen. Jeanne Shaheen, one of the negotiators, said Wednesday she did not know the deadline for negotiators to present the bill. She also dismissed the possibility of changes to the way the ACA deals with abortion.
“There is no need to compromise because it is already addressed in the Affordable Care Act,” Shaheen said. “There’s a very specific way to go about it. And I think that applies to anything that happens with the Affordable Care Act.”
Shaheen said Thursday’s vote in the House would “give momentum” to Senate negotiators.
