The House passed a three-year extension of the Affordable Care Act’s enhanced subsidies on Jan. 8, adding to the political drama surrounding health care affordability since last year, when it was cited as part of the reason for a record-breaking government shutdown.

The bill passed 230–196 with the help of 17 Republicans who went against the wishes of party leaders.

Rep. Jason Smith (R-Mo.) called the bill a subsidy for the rich.

“Any support of the bill ensures subsidies go to wealthy families making as much as $600,000 a year,” Smith said during the debate.

Rep. Richard Neal (D-Mass.), who helped create Obamacare, described the bill as a victory for affordable health care.

“The [Affordable Care Act] is still standing, and we will continue to improve it every single year,” Neal said.

The measure now heads to the Senate, where the clean, three-year extension of the subsidies, which expired on Dec. 31, 2025, will require 60 votes for passage—although a bipartisan compromise could be successful.

Affordability of Health Insurance

The battle over extending the enhanced subsidies reveals the major philosophical difference between Republicans and Democrats on how to improve the affordability of health insurance.

Democrats have argued that the subsidies, which began in 2021 as a response to the economic impact of the COVID-19 pandemic, have become a necessity because of the spiraling cost of health insurance.

House Minority Leader Hakeem Jeffries (D-N.Y.) said the three-year extension is necessary to prevent millions of Americans from facing large increases in premiums, co-pays, and deductibles that would prevent them from seeking medical care.

An effort to make the subsidies permanent failed to advance in the Senate in December 2025.

Republicans agree that the premiums are unaffordable but see the subsidies themselves as the problem.

The subsidies are paid directly to insurance companies on behalf of enrollees, which Republicans say has caused price inflation.

“I think we’ve all been very clear, and the president’s been very clear, about not subsidizing insurance companies rather than making sure that we can help the American people,” Rep. Chip Roy (R-Texas) told reporters on Jan. 7.

Many Republicans favor providing financial assistance for health care directly to consumers through Health Savings Accounts, which they say would encourage competition and bring down prices.

A proposal to that effect also failed to advance in the Senate in December 2025.

Bipartisan Talks

Senate Minority Leader Chuck Schumer (D-N.Y.) said the House’s three-year extension of the enhanced subsidies would pass in the Senate, despite the staunch opposition of some Republicans.

“The American people should ask [Majority Leader John Thune (R-S.D.)], ‘Are you willing to put this bill that the House now is moving forward on on the floor of the Senate?’ because it will pass.”

Asked about the possibility of a bipartisan agreement, Sen. Brian Schatz (D-Hawaii) said he doubted it was possible.

“I can’t even find seven or eight [Republicans] who are interested in the discussion, let alone 13 people who are going to vote ‘yes,’” Schatz told reporters on Jan. 6. “My observation is they don’t have the votes.”

Sens. Susan Collins (R-Maine) and Bernie Moreno (R-Ohio) are leading an effort among some Senators to craft a bipartisan compromise.

The ideas under discussion include a two-year extension of the enhanced subsidies accompanied by some program reforms in the first year and more substantial reforms in the second year, Collins told reporters on Jan. 6.

Thune previously said he would consider working with Democrats on premium reductions under the right circumstances.

“Our views on health care and the Democrats’ views on health care are very different,” Thune told reporters on Dec. 16.

“But if they’re willing to accept changes that actually would put more power and control and resources in the hands of the American people, and less of that in the pockets of the insurance companies, I think there’s a path forward.”

Election Politics

“Democrats are going to make health care and the high cost of living the No. 1 issue for all of 2026,” Schumer told reporters.

When later asked whether he would consider a bipartisan compromise in the Senate that fell short of a three-year extension, Schumer declined to answer directly but said, “[The Republicans have] got to get their act together, and they don’t have it right now.”

Republicans, including House Republican Caucus Leader Lisa McClain (R-Mich.), have accused Democrats of making unrealistic proposals in order to keep the focus on health.

“They want health care to be an issue. Republicans actually want solutions for Americans to bring down premiums, not subsidies,” McClain said at a Dec. 16 press conference.

Sen. Peter Welch (D-Vt.) denied that in comments to reporters on Dec. 11.

“I’ll speak for myself,” Welch said. “I do not want the issue. I want a solution.”

A permanent extension of the subsidies would add $350 billion to the federal deficit from 2026 to 2035 and increase the number of people with health insurance by 3.8 million, according to the Congressional Budget Office.

Fraudulent enrollment costs taxpayers up to $20 billion per year, according to an analysis by think-tank Paragon Health Institute.

Republicans voting in favor of the three-year extension were Reps. Rob Bresnahan (Pa.), Mike Carey (Ohio), Monica De La Cruz (Texas), Brian Fitzpatrick (Pa.), Andrew Garbarino (N.Y.), Jeff Hurd (Colo.), David Joyce (Ohio), Thomas Kean (N.J.), Nick LaLota, (N.Y.), Mike Lawler (N.Y.) Ryan Mackenzie (Pa.), Max Miller (Ohio), Zach Nunn (Iowa), Maria Salazar (Fla.), David Valadao (Calif.), Derek Van Orden (Wis.), and Rob Wittman (Va.).