Millions of Americans could see changes to their health care coverage at the end of January if Congress does not quickly move to extend expanded Affordable Care Act (ACA) tax credits this week.
Why It Matters
ACA tax credits expanded during the COVID-19 pandemic to allow more Americans to gain access to insurance are set to expire at the end of the year. Congress has been embroiled in a battle over its expansion. Democrats are warning that millions of Americans will either lose their coverage or see costs jump in the new year if the credits are not expanded. But Republicans, who have opposed the ACA, mostly do not support expanding the credits, with the exception of a handful of moderates representing swing districts.
More than 24 million people have health care coverage through the ACA marketplace. About 22 million Americans could see increased premium payments in 2026 if the tax credits are not extended, according to a report by KFF; others may lose the subsidy completely.
What to Know
Whether to schedule a vote on extending the credits has divided House Republicans. Centrist Republicans from swing districts—many facing potentially tight races in the 2026 midterms—have pushed for a vote, arguing that the subsidies help keep coverage affordable for their constituents.
Republicans have introduced their own bill, known as the Lower Health Care Premiums for All Americans Act. Some centrists had hoped the House would consider an amendment to that bill extending the ACA tax credits, but Speaker Johnson said Tuesday that no vote would be held on such an amendment.
“There’s about a dozen members in the conference in these swing districts that are fighting hard to make sure that they reduce costs for all of their constituents. Many of them did want a vote on this Obamacare COVID-era subsidy that the Democrats created. We looked for a way to try to allow for that pressure release valve, and it just was not to be,” Johnson said during a press conference.
Instead, GOP leaders plan to move forward with their bill. Even if it clears the House, it remains unclear whether the Senate could pass it by the end of the year.
That decision triggered sharp criticism from Representative Mike Lawler of New York, who told reporters that skipping a vote is “idiotic” and “political malpractice,” according to Fox News.
Jeffries has introduced a discharge petition supported by Democrats that would force a vote on a three-year extension of the subsidies. Representative Josh Gottheimer, a New Jersey Democrat, has introduced a petition to compel a vote on a one-year extension of the subsidies.
Gottheimer’s petition has drawn some bipartisan support. If every Democrat signs on, the petition could force a vote on a single-year extension. Representative Carlos Gimenez, a Florida Republican, became the latest to join the petition on Tuesday.
In the Senate last week, GOP Senators Bernie Moreno of Ohio and Susan Collins of Maine introduced a bill that would provide a two-year extension on the credits while eliminating zero-premium plans and capping income eligibility.
A KFF poll released earlier in December found that 84 percent of enrollees support extending the credits; among those respondents, 35 percent said they would blame Republicans in Congress and 41 percent said they would blame President Donald Trump if the tax credits expire. The poll surveyed 1,350 adults with ACA Marketplace coverage from November 7-15 and had a margin of error of plus or minus 3.3 percentage points.
A Gallup poll released this week, meanwhile, found that a record number of people believe the health care system is in a “state of crisis.”
What People Are Saying
House Majority Leader Steve Scalise, a Louisiana Republican, told reporters: “I think after everybody talked, they decided they didn’t want to go forward with the options that were out there.”
House Democratic Leader Hakeem Jeffries said last week: “There are only five legislative days left before the Affordable Care Act tax credits expire. And we have yet to see a Republican plan to prevent tens of millions of Americans from experiencing dramatically-increased premiums, co-pays and deductibles. We know that premium increases in some cases will be $1,000 or $2,000 per month. This is going to make healthcare unaffordable for millions of working class Americans, middle class Americans and everyday Americans.”
Representative Ami Beri, a California Democrat, wrote on X: “Every single House Democrat has signed a discharge petition to force a vote on extending ACA subsidies. We only need FOUR Republicans to stand up to Speaker Johnson and join us in protecting access to affordable, quality health care for over 20 million Americans.”
Senator John Cornyn, a Texas Republican, wrote to X: “Democrats are the ones that created Obamacare & have destroyed the healthcare system. They are trying to deflect the blame & have ZERO intention of coming up with a solution.”
What Happens Next
Lawmakers have a narrow window to pass legislation extending the ACA subsidies before the deadline, with internal House divisions—and competing proposals in both chambers—still unresolved.
