WASHINGTON (AP) — Speaker Mike Johnson had a ready-made refrain when asked why Republicans weren’t moving to expand federal health care subsidies: Their party wanted to help 100 percent of Americans with their costs, not just the 7 percent of Americans enrolled in Affordable Care Act plans.
But not 100% of his conference agreed.
A rare revolt by the moderate wing of the party changed Johnson’s plans. Four Republicans this week signed a Democratic discharge petition that guarantees the House will vote on extending the ACA subsidies sometime in January, with Republican leaders now powerless to stop it.
For Democrats, it was the vindication of a months-long strategy, beginning with the fall government shutdown, that pushed the expiration of the ACA’s support to the forefront of politics. Republicans in competitive districts most at risk of losing their seats in next year’s term felt the political pressure when they heard from voters about their rising premiums.
“Nothing has changed with the House Republican leadership, but something has changed within their own ranks,” said Rep. Pete Aguilar, chairman of the House Democratic Caucus.
Flanked by his caucus Thursday on the Capitol steps, House Democratic Leader Hakeem Jeffries asked Johnson to allow a vote on a three-year extension of ACA subsidies before lawmakers leave for the holidays: “Not tomorrow. Not next week. Not next year. Today.”
Johnson declined, saying he “will be on the floor the first week of January when we come back.”
Parliamentarians are preparing to go into limbo
The impasse left lawmakers with a cliffhanger as they headed home for the holiday break. Republican leaders are now facing mounting pressure to placate centrist members who are threatening to join Democrats to approve a three-year extension of Affordable Care Act subsidies.
Senate Majority Leader John Thune also has to deal with this issue. Any ACA bill that clears the House would simply take the fight to the Senate, which has already rejected a three-year extension.
A bipartisan group of senators met and discussed possible compromise bills that would expand the grants but put new limits on them. But they didn’t have anything in mind until January.
Thune told reporters Thursday that a three-year extension of “a failed program that is riddled with fraud, waste and abuse” is not happening.
However, Republican leaders in both chambers have not offered a plan that fully addresses members’ concerns about the steep increases in insurance costs that many Americans are expected to face in 2026 and possibly beyond.
The White House has been involved in discussions about the health care proposals, but has largely allowed Republicans to resolve their internal divisions and coalesce around a plan on their own, according to a senior administration official involved in the discussions, who spoke on condition of anonymity to discuss private discussions.
House Republicans on Wednesday passed a more than 100-page health care package centered on longtime GOP priorities, including expanding coverage options for small businesses and the self-employed. The bill would also rein in pharmacy benefit administrators — middlemen who manage drug costs and process insurance claims.
Johnson said the measure is “a bigger, better, more important thing for 100 percent of Americans, not just 7 percent of Americans.” But some Republicans facing tough re-election bids remain fixated on the looming increase in ACA costs.
The holidays give Johnson a brief window to try to persuade moderates to abandon the effort. The discharge petition froze once it reached 218 signatures, meaning that while only four Republicans have publicly signed on, more may be willing to support the Democratic bill.
Representative Ryan Mackenzie, one of four Republicans who signed the Democratic petition, said it has “generated more conversation” and that “we hope that in the next three weeks, we will actually see some changes in some bipartisan efforts that can actually generate a meaningful vote that gets 218 in the House and 60 in the Senate.”
“I think allowing a vote is extremely important,” Mackenzie said. “I think everyone should be able to vote on the board, and they should be able to allow everyone in the American public to see how they voted on these individual issues.”
Leader Jeffries’ waiting game is paying off
For months, Jeffries refused to support a one-year extension of ACA subsidies that a bipartisan group of lawmakers was pursuing, dismissing it as a “non-starter” and “a laughable proposal.”
Instead, he stood firm on a three-year extension with no income cap or cost offset. That strategy paid off, as GOP moderates were forced to turn in his direction when Johnson refused to allow any vote on an ACA extension.
Jeffries has faced criticism this year from progressive members of his caucus and grassroots groups, who have urged him to push harder against Trump and Republicans. But on Thursday, much of the party rallied behind him on the Capitol steps, 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, while Democrats secured a vote, insurance costs for millions will rise next year, and passage of a three-year extension of ACA subsidies remains a long shot even if it passes the House. Senate Republicans have already rejected the three-year extension, but some GOP senators who are open to a deal on the subsidies said a House vote could provide momentum.
“We could have a vehicle — if we could get Republicans and Democrats behind it — then we could send it back,” GOP Sen. Thom Tillis said, adding that “it means there’s still a chance.”
For Democrats, the fight also allowed them to rally around a message they believe could prove powerful on the campaign trail.
“The Republican health care crisis is unacceptable, unconscionable and un-American,” Jeffries said.
A Republican House Divided
The decision by four Republicans to break away from 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 repeatedly bypassing the leadership to force votes — is inevitable given the GOP’s slim majority. He said it lacked the advantages of a large majority, where “the speaker had a long stick with which to administer punishment”.
“I don’t have that, because we have a small margin,” he said. On the ACA extensions, Johnson said leadership has “discussed this extensively” with GOP moderates, describing the conversations as “intense fellowship.”
“Everyone is in good spirits now and everyone understands what’s going on,” he added.
Some GOP members, however, don’t seem to share that assessment. There was lingering discontent as MPs headed home for the holidays.
“I don’t know how we didn’t vote for a good bipartisan extension,” said GOP Rep. Don Bacon, adding that Democrats will use the health care issue “like a sledgehammer” in the campaign.
House Majority Leader Steve Scalise, R-La., insisted Republicans are ending the year “as united as we’ve ever been.”
“We set out on a course 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 reporter Mary Clare Jalonick and Kevin Freking contributed to this report.