Republican infighting on healthcare erupts in US House as subsidy expiration approaches

WASHINGTON: An expanded US federal healthcare subsidy that grew out of the pandemic looked all but certain to expire on Dec 31 as Republican leaders on Wednesday (Dec 17) faced a rebellion within their ranks in support of a Democratic-backed extension of the “Obamacare” benefit.

By a vote of 204-203, the House voted to stop the last-minute move by Democrats, aided by four Republicans, to force quick votes on a three-year extension of the Affordable Care Act subsidy. Democrats loudly protested, accusing Republican leadership of gavelling an end to the vote prematurely while some members were still trying to vote. 

“That’s outrageous,” Democratic Representative Jim McGovern of Massachusetts yelled at Republican leadership.

Some of the 24 million Americans who buy their health insurance through the ACA programme, nicknamed Obamacare, could face sharply higher costs beginning on Jan 1 without action by Congress. 

Democratic Representative Rosa DeLauro of Connecticut said Democrats were trying to vote before the vote was closed.

“Listen, it’s playing games when people’s lives are at stake,” DeLauro said, “They jettisoned it.”

Twenty-six House members had not yet voted – and some were actively trying to do so – when the House Republican leadership gavelled the vote closed on Wednesday. It is rare but not unprecedented for House leadership to cut a contested vote short.

The political intrigue could continue later on Wednesday with separate healthcare legislation being pushed by House Speaker Mike Johnson and his lieutenants.

The House Republican leadership bill aims to lower premiums for some people while reducing overall subsidies and raising premiums for others, starting January 2027. It would also expand access to association health plans, which allow small businesses, freelancers, and self-employed individuals to pool resources and purchase group health insurance at potentially lower costs.

The nonpartisan Congressional Budget Office on Tuesday said the legislation would decrease the number of people with health insurance by an average of 100,000 per year through 2035. Its money-saving provisions would reduce federal deficits by US$35.6 billion, the CBO said.

Earlier in the day, Republican leadership corralled some of their members working with the Democrats into animated conversations with finger-pointing. On the House floor, House Majority Leader Steve Scalise leaned over Representative Mike Lawler from New York. Johnson tugged on the coat sleeve of Representative Kevin Kiley, a California Republican, to get answers from him as he has been critical of his leadership’s approach to healthcare legislation.

Kiley later said in a floor speech that he would support the Republicans’ targeted healthcare bill despite reservations. “The bill does not address the immediate, urgent problem in front of us, which is that 22 million people are about to pay a lot more for health insurance,” Kiley said. 

With a narrow 220-213 majority, House Speaker Mike Johnson has had a challenging time keeping his caucus in line, and has repeatedly seen members use the manoeuvre Democrats were attempting, known as a “discharge petition” to try to bypass him.

The Senate, also controlled by President Donald Trump’s Republicans, last week rejected duelling Republican and Democratic plans to address the subsidies.

SUBSIDIES CAUSE OF GOVERNMENT SHUTDOWN

Tensions are high over the expiring ACA subsidies, which were the cause of the record-breaking government shutdown earlier this fall. Democrats withheld their support of a temporary government funding bill unless the ACA subsidy was extended. Republicans refused that demand.

The debate over healthcare  – one that has pitted Republicans against Democrats for decades – is more than a policy matter. The November 2026 congressional elections hang heavy over lawmakers at a time when Republican President Donald Trump’s public approval rating is an emic and Democrats see an electoral landscape that they think could propel them into a House, and maybe even a Senate, majority beginning in 2027. 

Democrats have pledged to make the cost of healthcare and other “affordability” worries central to their 2026 campaigns.

The four Republicans who joined forces with House Democratic Leader Hakeem Jeffries in trying to advance a three-year ACA subsidy extension represent districts that could see competitive re-election races next year. Three of them come from the swing state of Pennsylvania, with the fourth from New York.

Even if the Republican-controlled House managed to pass a healthcare bill this week, it is unlikely to be taken up by the Senate before Congress begins a looming end-of-year recess that would stop legislative action until Jan 5. By then, millions of Americans will be looking at significantly more expensive health insurance premiums that could prompt some to go without coverage.

Wednesday’s House floor battle could embolden Democrats and some Republicans to revisit the issue in January, even though higher premiums will already be in the pipeline.

Referring to the House debate, moderate Republican Senator Lisa Murkowski told reporters: “I think that that will help prompt a response here in the Senate after the first of the new year, and I’m looking forward to that.”