House Passes Key Bill Without ACA Subsidies
House Republicans on Wednesday approved a conservative healthcare package aimed at lowering insurance premiums without extending the temporary Obamacare subsidies set to expire later this year, highlighting a clear policy divide with Democrats ahead of the 2026 midterm elections.
The legislation, titled the Lower Health Care Premiums for All Americans Act, passed the House by a mostly party-line vote of 216–211. Rep. Thomas Massie of Kentucky was the only Republican to vote against the bill, siding with Democrats.
Although the measure is unlikely to advance in the Democrat-controlled Senate, Republican leaders said the vote was intended to demonstrate that the GOP is offering a different approach to healthcare reform — one focused on long-term affordability rather than continuing short-term government subsidies tied to the Affordable Care Act.
No Extension of Expiring Obamacare Subsidies
Unlike Democratic proposals, the Republican bill does not extend the enhanced Obamacare tax credits scheduled to expire on December 31. Democrats warn that allowing those subsidies to lapse could affect roughly 22 million Americans who currently receive assistance.
Republicans dispute that characterization, arguing that the expanded subsidies primarily benefit a limited share of the population while failing to address the underlying drivers of rising healthcare costs nationwide.
Conservative Reforms Focused on Competition and Affordability
Instead of extending subsidies, the GOP package emphasizes reforms long supported by conservatives. The bill includes funding for cost-sharing reductions intended to stabilize premiums, reforms targeting pharmacy benefit managers — the powerful middlemen involved in prescription drug pricing — and an expansion of association health plans.
Association health plans allow individuals and small businesses to band together to purchase insurance at lower group rates, a policy Republicans say increases competition and consumer choice.
Deficit Reduction and Lower Premiums, CBO Says
According to the nonpartisan Congressional Budget Office, the bill would reduce the federal deficit by approximately $35.6 billion over the next 10 years, through 2035.
The CBO also estimated the legislation would slightly reduce insurance enrollment by about 100,000 people per year, while lowering benchmark health insurance premiums by an average of 11 percent over the same period.
Divisions Emerge Within GOP Conference
Despite its passage, the vote exposed internal divisions among House Republicans. Speaker Mike Johnson of Louisiana has faced pressure from moderates representing competitive districts who favor extending the Obamacare subsidies with reforms attached.
Talks between Republican leadership and centrist lawmakers broke down earlier this week. As a result, four House Republicans joined Democrats in signing a discharge petition seeking to force a vote on a three-year subsidy extension.
Rep. Mike Lawler of New York, one of the Republicans backing the petition, said leadership left moderates with few alternatives.
“I still believe a straight three-year extension is not the right policy,” Lawler said. “But doing nothing is even worse.”
Republicans Say Focus Is on All Americans
GOP leaders maintain their approach is about lowering healthcare costs for everyone, not continuing temporary subsidies tied to Obamacare.
“Democrats are focused on protecting benefits for about six percent of the country,” said Rep. August Pfluger of Texas. “Republicans are focused on lowering costs for 100 percent of Americans.”
As healthcare policy remains a central issue heading into the midterm elections, Republicans say the vote underscores a broader debate over whether Congress should continue expanding federal subsidies or pursue long-term reforms aimed at affordability, competition, and fiscal responsibility.
