House Republicans Block Vote on ACA Subsidy Extension

Today, the Republican-controlled House blocked a Democratic effort to quickly pass a 3-year extension of Affordable Care Act (ACA) subsidies, voting 204-203 to end the last-minute push before the subsidies expire on December 31, according to Reuters.¹

Democrats accused leadership of prematurely closing the vote, while tensions on the House floor highlighted divisions within the GOP and concerns over the impact on Americans relying on the subsidies. The move makes it unlikely the legislation will advance before the deadline.

Ahead of a House procedural vote, 4 Republican moderates—Brian Fitzpatrick (Pennsylvania), Mike Lawler (New York), Rob Bresnahan (Pennsylvania), and Ryan Mackenzie (New York)—broke with party leadership to join a Democratic discharge petition forcing a vote on extending expiring ACA subsidies, according to The Hill. Despite this rebellion, they later supported the GOP plan that did not include the subsidy extension, highlighting tensions within the narrowly divided House as Republicans prepare for the 2026 midterms. Meanwhile, Speaker Mike Johnson (R, Louisiana) insisted he retains control, noting the unusual challenges of managing the smallest House majority in history.

Earlier this month, both Democratic and Republican health care plans failed to advance in the Senate, with votes of 51-48 for each.³ The proposal for a 3-year extension of the enhanced subsidies would maintain affordability for millions, whereas Republicans offered a plan redirecting funds to health savings accounts that would not cover premiums.

What Are the Implications?

If the ACA subsidies are blocked, millions of Americans could see their health insurance premiums rise dramatically, with some middle-income families facing more than double their current costs.⁴ Up to 4 million people could lose marketplace coverage, leaving many in a gap where they earn too much for Medicaid but cannot afford full-priced insurance. The loss of subsidies would particularly affect older adults and those in high-cost states, creating coverage instability and forcing some to drop or downgrade their plans. Financial hardship would increase, as households pay a larger share of premiums and may delay or forgo necessary care. Hospitals, rural providers, and community health centers would face higher uncompensated care burdens, further straining the health system and exacerbating existing disparities in access and outcomes.

Impact on Employee Health Plans

If the ACA subsidies expire, employees could face significantly higher premiums and may need to explore alternative coverage options, such as Individual Coverage Health Reimbursement Arrangements (ICHRAs).⁵ Under an ICHRA, employees choose their own marketplace plans and receive employer reimbursement, which can help offset costs, but many may struggle to pay premiums upfront without employer facilitation. As a result, some employees—especially those who are relatively healthy—might drop coverage or downgrade to lower-tier plans, whereas others who rely heavily on care will face tough decisions about affording necessary treatment. This shift also requires employees to become more engaged in selecting and managing their coverage, navigating a more complex individual market than traditional employer-sponsored plans.

“For employers who are looking at, ‘What do we do right now?’ I know so much of the focus is on the ACA right now and what's going to happen with these rates when the tax credits go away, but people aren't talking quite as much about the fact that even the traditional group rates have not been all that good this year,” said Ben Light, VP of partnerships at Zorro and expert in ICHRAs, in an interview with The American Journal of Managed Care® (AJMC®). “We see a lot of companies that are exploring the ICHRA because they've gotten a 20%, 25%, 40%, or 50% renewal on their traditional group plan. I think you're going to have people looking at the ICHRA because it's a shift of risk, and you're moving that risk from the population, just in your company now, out to the individual market.”

As the expiration of ACA subsidies approaches, the choices facing both employees and employers are becoming increasingly urgent. Without congressional action, millions of Americans could face higher premiums, reduced coverage, and increased financial strain, while employers may turn to alternatives like ICHRAs to help mitigate rising costs and shift risk.

References

1. Cowan R, Erickson B. US House Republicans block move for quick vote on health subsidy extension. Reuters. December 17, 2025. Accessed December 17, 2025. https://www.reuters.com/world/us-house-republicans-block-move-quick-vote-health-subsidy-extension-2025-12-17/

2. Live updates: 4 Republicans join Dems’ ObamaCare discharge petition; GOP health plan passes procedural vote. The Hill. December 17, 2025. Accessed December 17, 2025. https://thehill.com/homenews/administration/5651317-live-updates-trump-obamacare-ndaa/

3. Bonavitacola J. Bills to address expiring ACA subsidies fail to pass senate. AJMC. December 11, 2025. Accessed December 17, 2025. https://www.ajmc.com/view/bills-to-address-expiring-aca-subsidies-fail-to-pass-senate

4. Steinzor P. 5 consequences if ACA premium subsidies end in 2026. AJMC. October 31, 2025. Accessed December 17, 2025. https://www.ajmc.com/view/5-consequences-if-aca-premium-subsidies-end-in-2026

5. McCrear S, Light B. What ACA subsidy expiration means for coverage costs, employer strategy, and ICHRAs: Q&A with Ben Light. AJMC. December 2, 2025. Accessed December 17, 2025. https://www.ajmc.com/view/what-aca-subsidy-expiration-means-for-coverage-costs-employer-strategy-and-ichras-q-a-with-ben-light