Members of the U.S. House today voted 221-205 to bring an Affordable Care Act health insurance premium subsidy bill resolution up on the House floor, against the wishes of Republican House leaders.
The resolution could lead to floor consideration of an ACA premium subsidy bill.
The underlying bill could keep the high ACA premium subsidy levels that were in effect in 2025 in place for three more years.
Debate on the bill consideration resolution began shortly after passage of a motion to approve a discharge petition, but House leaders postponed the vote on the resolution.
All Democrats who participated voted for a motion for debate of the bill consideration resolution, as did nine of the 214 Republicans who participated.
Whatever happens to the vote on the resolution or the bill, the success of the discharge petition may be a sign that some kind of ACA subsidy bill has a chance to get through Congress.
Before any ACA subsidy bill could become law, President Trump would have to sign it, or, if the president vetoed the bill, Congress would have to overturn the veto. To override a veto, a bill’s supporters need to obtain support from two-thirds of the lawmakers voting on a veto override in both the House and the Senate.
What it means: Any dealmaking surrounding efforts to pass or block an ACA subsidy boost extension bill could create opportunities for lawmakers to promote bills that would tighten rules for employers’ pharmacy benefit managers, provide a new legislative framework for individual coverage health reimbursement arrangements, or ease the rules for users of health savings accounts.
The backdrop: The Affordable Care Act originally provided premium subsidies for people with income under 400% of the federal poverty limit who buy their own individual or family coverage through an Affordable Care Act public exchange.
Congress responded to the COVID-19 pandemic by increasing the generosity of the subsidies and making the subsidies available to people at any income level if the full cost of standard coverage would cost more than about 9% of their income. The subsidy boost expired at the end of 2025.
Analysts have predicted that expiration of the temporary COVID-era subsidy boost would lead to the average out-of-pocket cost of coverage doubling for typical exchange plan users. But some older exchange plan users with income over 400% of the federal poverty level have reported that they believe the cost of keeping coverage in place could be more than five times higher.
The subsidy boost expiration will have a direct effect on small business owners who go without health benefits and assume that employees will use exchange plan coverage.
The expiration could also have an indirect effect on employer-sponsored health plans, if a big increase in the number of people without any health coverage leads hospitals to cope with a spike in the number of charity care patients by increasing prices for insured patients.
The subsidy boost extension bill: The subsidy boost extension bill heading toward the House floor is really an amendment to another bill, the Breaking the Gridlock Act.
The discharge resolution: Bill supporters can use a discharge petition to get around the usual House rules and arrange for the full House to vote on a bill that’s opposed by House leaders.
House members rarely try to start discharge petitions, and the discharge petitions started rarely succeed.
House members have filed fewer than 100 discharge petitions since 2011, and petition organizers have succeeded at attracting the support of a majority of House members for only seven of the petitions, according to analysts at Everything Policy.
In this case, four Republican House members helped put the petition into effect in December by pulling away from other Republican House members and agreeing to sign the petition.
The petition gave bill supporters the right to make the House vote on a motion calling for consideration of House Resolution 780, which, in turn, calls for consideration of the subsidy boost extension bill.
Lawmaker persepctives: Rep. Mike Lawler, R-N.Y., one of the Republicans who voted for the motion to discharge the bill consideration resolution to the House floor, said on the House floor that he and other Republicans had worked with Democrats to create a bill that would keep a high level of premium subsidies in place for two years but address some Republican concerns about the subsidies, by taking steps such as eliminating subsidy access for people with a very high level of income and requiring all subsidy users to pay a minimum level of premiums per month, to keep crooks from enrolling low-income people in coverage without their knowledge.
“Unfortunately, we could not get that bill to the floor for a vote,” Lawler said.
Lawler said he will vote for the Democrats’ three-year subsidy boost extension bill to give negotiators in the Senate to chance to create a package that protects consumers against huge, sudden increases in health coverage costs while addressing provisions in the ACA that appear to encourage insurers to increase their premiums.
“Our system is broken, and we need to fix it, and we need to work in a bipartisan way,” Fitzpatrick said.
Rep. Brett Guthrie, R-Ky., the chairman of the House Energy and Commerce Committee, who voted against the bill consideration resolution, said his committee will hold hearings on why health insurance costs are so high.