The U.S. House of Representatives has approved a Republican-led healthcare bill that does not include the renewal of expanded Affordable Care Act (ACA) premium subsidies, even as those subsidies are set to expire at the end of 2025. The legislation passed by a 216-211 vote, largely along party lines, in the final healthcare policy decision of the year. This vote came amid heightened debate and partisan divisions in Congress.
Enhanced premium tax credits under the ACA, originally expanded during the COVID-19 pandemic to make coverage more affordable, will likely lapse unless new action is taken when lawmakers return in January 2026. These tax credits have been a key factor in reducing out-of-pocket costs for millions of Americans buying insurance through the ACA marketplaces.
Democratic lawmakers strongly opposed the Republican measure and sought to extend the subsidies for several years through procedural maneuvers, but those efforts failed. The decision sets the stage for significant increases in insurance costs starting in 2026 and renewed legislative fights in the new Congress.
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House Vote and Legislative Context
In mid-December 2025, the House of Representatives voted narrowly to approve the Republican healthcare package by 216 votes to 211 without extending the expiring ACA subsidies.
House Republican leaders prioritized moving forward with broader healthcare reform goals rather than renewing the enhanced tax credits. Their bill aims to reshape federal involvement in health coverage and curb long-term spending on subsidies, although it will not prevent the imminent lapse of the pandemic-era financial support.
Democrats attempted to force a separate vote on extending the subsidies for three years using a discharge petition, but that effort was blocked immediately before the final vote on the Republican bill. Moderates within the GOP joined Democrats in supporting the petition, reflecting internal disagreements on the strategy and timing of healthcare policy.
The procedural moves and opposition highlight the complex dynamics of the 118th Congress, with healthcare remaining a deeply contentious issue between and within parties as lawmakers prepare for the 2026 election cycle.
🚨 JUST IN: House PASSES GOP healthcare bill 213-209!
Allows Americans to band together in groups for cheaper insurance premiums, REAL savings WITHOUT extending Democrats’ massive ACA subsidies to Big Insurance giants.pic.twitter.com/7qb87fgA7v
— Gunther Eagleman™ (@GuntherEagleman) December 17, 2025
Elements of the Republican Healthcare Bill
The healthcare bill passed by the House includes several major changes to current federal policy, with a focus on reducing certain subsidies and promoting alternative insurance models:
- The legislation does not renew enhanced ACA premium tax credits that have helped reduce monthly payments for millions of enrollees.
- It proposes a reduction in overall subsidies beginning in 2027, which may reshape how federal aid supports insurance markets over time.
- The bill would increase access to association health plans, allowing small businesses and self-employed individuals to pool together for group insurance options.
- There are provisions intended to improve transparency in drug pricing and establish cost-sharing reduction payments for certain marketplace enrollees.
Despite these elements, the absence of an extension of enhanced premium credits remains the central and most debated feature of the bill’s impact.
🚨 BREAKING: The U.S. House has just PASSED the Republican healthcare plan that lets people buy insurance in groups to save money on premiums, WITHOUT Democrats’ ACA subsidies extension for Big, Rich Insurance.
The vote was 216-111
One Republican NO: Thomas Massie pic.twitter.com/ZSAspTnmCO
— Eric Daugherty (@EricLDaugh) December 17, 2025
Projected Effects on Health Insurance Coverage
Without renewal of the enhanced tax credits, many Americans buying insurance through ACA marketplaces could face higher costs in 2026 and beyond. Estimates indicate that average premiums could more than double in the new year, significantly affecting household budgets.
The Congressional Budget Office (CBO) has projected that the Republican bill could reduce the number of insured people by an average of about 100,000 per year through 2035, a gain in federal savings but also a potential increase in the number of uninsured Americans.
Kaiser Family Foundation data show that enhanced tax credits currently help keep premiums lower for consumers of all income levels. With those credits set to expire, many enrollees may see their monthly premiums rise sharply, with lower-income families and small business owners facing particular strain.
State-level analyses suggest that premium increases could vary significantly by location and income, with some older middle-income households experiencing especially steep cost jumps.
Political and Future Outlook
Following the House vote, the Republican bill now moves to the U.S. Senate, where its prospects before the end-of-year recess are unclear. Many Senate Republicans have shown reluctance to take up the proposal before lawmakers break for holidays, meaning substantive debate is expected to resume in January 2026.
Meanwhile, Senate Democrats and moderate Republicans have continued discussions around alternative proposals that could extend subsidies or modify the structure of financial assistance to help mitigate premium spikes. Some bipartisan negotiations have explored shorter or more targeted subsidy extensions, including income-based limits or mixed policy solutions, though no final agreement has been reached.
The expiration of enhanced subsidies and the continued stalemate in Congress are likely to influence broader healthcare debates and campaign messaging leading into the 2026 midterm elections. Lawmakers from competitive districts have emphasized the constituent impact of rising costs, keeping healthcare high on the political agenda as legislative work resumes.