House Passes Three-Year ACA Extension

On Thursday, in a rebuke to the GOP party line, the House of Representatives voted 230-196 to extend the Affordable Care Act’s enhanced premium subsidies for three more years. 17 Republicans defected to join all Democrats in voting for the legislation, after the end of the subsidies sparked the longest-ever federal government shutdown late last year.

It remains to be seen whether the extension will pass the Senate, where a similar three-year extension vote failed in December—but cheers could be heard in the House chamber on C-SPAN after the vote.

Rep. Nancy Pelosi (D-Calif.), the former House Speaker who played a key role in the 2010 passage of the ACA, posted on X that “today is a happy day” and that “the Senate must immediately take up this bill to ensure no American is pushed out of coverage.”

Today is a happy day. House Democrats have passed a bill to extend Affordable Care Act tax credits so health care remains affordable and accessible for America’s working families.

The Senate must immediately take up this bill to ensure no American is pushed out of coverage.

— Nancy Pelosi (@SpeakerPelosi) January 8, 2026

At the end of last year, enhanced subsidies expired due to Republicans’ and Democrats’ inability to reach a deal on the Biden-era expansion, leaving many Americans facing record premium spikes. As I previously reported, Republican politicians have pushed for a health savings account model, which has shortcomings for people with high health care costs.

It’s unclear how many fewer people signed up for ACA marketplace plans for 2026 by December 15, as the Centers for Medicare and Medicaid Services has not released data since December 5. ACA marketplace enrollment remains open through January 15. KFF estimates that the average cost of ACA marketplace plans has increased by 26 percent this year.

Thursday’s vote involved sidestepping Republican House Speaker Mike Johnson (R-La.), who has shepherded GOP opposition to ACA benefits, with a vote yesterday for a discharge petition to bring the vote for a three-year extension to the floor. Nine relatively moderate Republican representatives defected from Johnson to join a party-line Democratic vote for the discharge petition.

During the debate that preceded the vote, many Democrats shared stories of constituents who faced the prospect of unaffordable health care without the enhanced subsidies. Some Republicans lamented that ACA marketplace plans can include abortion coverage, and claimed that the ACA benefits insurers more than patients.

If the extension passes the Senate and is signed into law by President Donald Trump, the nonpartisan Congressional Budget Office estimates that 6.2 million more people will be enrolled in ACA marketplace plans by 2029.

Now, the ball is in the Senate’s court.