With enhanced Affordable Care Act subsidies set to expire at the end of this year, House Speaker Mike Johnson is moving ahead with a Republican plan to address rising health costs without extending the credits. At the same time, bipartisan efforts in the House aim to force a vote on temporarily continuing the subsidies.
Building on the Senate's failure last week to advance competing Affordable Care Act (ACA) proposals, House Republicans are promoting alternative measures as the enhanced subsidies that help millions afford marketplace coverage approach their scheduled expiration at the end of this year, according to NPR.
NPR reports that House Speaker Mike Johnson, R-La., has set a vote this week on a package that does not include an extension of the ACA premium tax credits. The plan is described by Republicans as focused on tackling health care costs rather than subsidies, though specific elements of the package — such as changes to association health plans, new pharmacy benefit manager rules or additional funding for cost-sharing reductions — have not all been detailed publicly in NPR's coverage.
Opposition to Johnson's approach crosses party lines. In an interview with NPR, GOP Rep. Kevin Kiley, R-Calif., who supports a temporary extension of the credits, criticized the speaker's plan as "hastily thrown together" and said it does not address "the crisis in front of us," arguing that the more than 20 million people who rely on the ACA credits "shouldn't be forced to pay the price for congressional inaction." NPR has also reported that House Minority Leader Hakeem Jeffries, D-N.Y., has framed the stakes as a major affordability issue and has pressed for Congress to extend the subsidies, though he has not used the specific word "toxic" in NPR's reporting.
Separate from House leadership's proposal, some lawmakers are pursuing a bipartisan path. According to an NPR interview with Kiley, members from both parties have begun filing or preparing discharge petitions in an effort to force votes on plans to extend the ACA subsidies. These petitions would need majority backing in the House to succeed, though NPR has not confirmed specific sponsorship details or the exact duration of any proposed extension.
In the Senate, Republicans such as Sen. Bill Cassidy of Louisiana have also indicated an interest in combining an extension of the subsidies with broader health policy changes, NPR reports. Polling by the nonpartisan health policy group KFF has found that steep increases in health insurance premiums could influence how some voters view members of Congress, though NPR's summaries do not cite a specific figure such as a $1,000 annual increase tied directly to midterm vote choices.
NPR's coverage emphasizes that the looming deadline is creating anxiety as the ACA marketplace enrollment period nears its close and people brace for possible premium spikes if Congress does not act. Human rights and consumer advocates have warned that the loss of enhanced subsidies would force many enrollees to choose between paying sharply higher premiums or going without coverage, and KFF has estimated that average premium costs for subsidized marketplace plans would rise significantly if the enhanced credits lapse.
Under current law, if the temporary enhancements are not renewed, the ACA's original subsidy formula would resume. That system generally requires the lowest-income marketplace enrollees to pay a capped share of their income toward benchmark plans, with higher caps applying to those with higher incomes. Health policy analysts say that, for many families, this could mean monthly premiums that are hundreds or even thousands of dollars higher than they pay today.
Marketplace leaders and community groups told NPR they are already fielding more questions from consumers who are unsure whether Congress will act in time. While some individual enrollees have shared examples of what they expect to pay if subsidies expire, NPR has not published a verified set of named case studies with precise dollar-amount increases of the kind sometimes cited by advocacy groups, and actual premium changes will depend on local markets, plan choices and income.
As the House prepares to vote on Johnson's plan and as discharge petition efforts continue, it remains unclear whether Congress will reach a bipartisan agreement to extend the subsidies before the current enrollment period ends or before the higher costs show up in 2026 coverage.
