House passes bill to extend health care subsidies

WASHINGTON — In a remarkable rebuke of Republican leaders, the House passed legislation Thursday, by a vote of 230 to 196, that would extend expired health care subsidies for those who receive coverage through the Affordable Care Act, as renegade GOP lawmakers joined nearly all Democrats in voting for the measure.

The forced vote on the issue came after a handful of Republicans signed a so-called “discharge petition” to unblock debate, bypassing objections from House Speaker Mike Johnson. The bill now heads to the Senate, where pressure is mounting for a similar bipartisan compromise.

Together, the rare political coalitions are racing to resolve the impasse over enhanced tax credits that were put in place during the COVID-19 crisis but expired late last year after no agreement was reached during the government shutdown.

“The affordability crisis is not a ‘hoax,’ it is real, despite what Donald Trump has said,” said House Democratic Leader Hakeem Jeffries, invoking the president’s remarks.

“Democrats made it clear before the government fell that we will fight for affordability until we win this battle for affordability,” he said. “Today we have the opportunity to take a significant step forward.”

Illinois consumers face high health insurance prices with Obamacare subsidies still in limbo after the shutdown.

Before the vote, the nonpartisan Congressional Budget Office estimated that the bill, which would extend the subsidy for three years, would increase the nation’s deficit by about $80.6 billion over the decade. At the same time, it would increase the number of people with health insurance by 100,000 this year, by 3 million in 2027, by 4 million in 2028 and by 1.1 million in 2029, the CBO said.

Growing support for expanding ACA subsidies

Johnson, R-La., worked for months to avoid this situation. His office argued Thursday that COVID-19-era federal health care funding was rife with fraud, pointing to an investigation in Minnesota, and called for a no vote.

On the ground, Republicans have argued that the subsidies as they are structured have contributed to fraud and that the House should focus on reducing health insurance costs for the entire population.

“Only 7 percent of the population relies on Obamacare marketplace plans. This chamber should be in the business of helping 100 percent of Americans,” said Rep. Jason Smith, Republican chairman of the House Ways and Means Committee.

While the momentum of the vote shows growing support for tax breaks that have helped some 22 million Americans gain access to health insurance, the Senate would not be required to take up the House bill.

Instead, a small group of senators from both parties have been working on an alternative plan that could find support in both chambers and become law. Senate Majority Leader John Thune, R-S.D., said for any plan to find support in his chamber, it will have to have income limits to ensure financial aid is focused on those who need it most. He and other Republicans also want to make sure beneficiaries would have to pay at least a nominal amount for their coverage.

Finally, Thune said there should be an expansion of health savings accounts, which allow people to save money and withdraw it tax-free, as long as the money is spent on qualified medical expenses.

Sen. Jeanne Shaheen, D-N.H., who is part of the negotiations on reforms and grants for the Affordable Care Act, said there is agreement on combating health care fraud.

“We recognize that millions of people in this country are going to lose – are losing, have lost – their health insurance because they can’t pay the premiums,” Shaheen said. “So we’re trying to see if we can’t come to an agreement that might help, and the sooner we can do that, the better.”

Trump has pushed Republicans to send money directly to Americans for health savings accounts so they can bypass the federal government and manage their insurance themselves. Democrats largely reject the idea as insufficient to cover high health care costs.

Republicans bypass their leaders

The Republican action to force a vote was an affront to Johnson and his leadership team, who have essentially lost control of what happens in the House as Republican lawmakers joined with Democrats to find a workaround.

After last year’s government shutdown failed to resolve the problem, Johnson had considered giving the most politically vulnerable Republican lawmakers a chance to vote on another health care bill that would temporarily extend subsidies while adding changes.

But after days of discussions, Johnson and GOP leaders sided with the more conservative wing, which has criticized the subsidies as supporting the ACA, which they view as a failed government program. He offered a modest health care reform proposal that was approved, but has stalled.

That’s when rank-and-file lawmakers took matters into their own hands, as many of their constituents faced skyrocketing health insurance premiums starting this month.

Republican Reps. Brian Fitzpatrick, Robert Bresnahan and Ryan Mackenzie, all of Pennsylvania, and Mike Lawler of New York, signed the Democrats’ petition, pushing it to the magic number of 218 needed to force a vote in the House. All four represent key districts whose elections will help determine which party takes over the House next year.

Trump encourages Republican Party to tackle health care problem

What began as a long-shot effort by Democrats to propose a discharge petition became a political justification for Democrats’ government shutdown strategy as they fought to preserve health care funds.

Democrats are making clear that the higher health insurance costs facing many Americans will be the political centerpiece of their efforts to win back majorities in the House and Senate in the fall elections.

Trump, in a lengthy speech this week to Republican lawmakers in the House of Representatives, encouraged his party to take control of the health care debate — an issue that has stymied Republicans since he unsuccessfully tried to repeal Obamacare during his first term.

Associated Press writer Matt Brown contributed to this report.