Overview: Moderate and vulnerable Republicans in both the Senate and House are pushing GOP leaders to extend enhanced ACA premium subsidies before they expire in January, warning that premiums could skyrocket and force many off coverage. Four Senate Republicans voted to advance a three-year Democratic extension, while House members filed discharge petitions to force one- and two-year votes with eligibility and anti-fraud changes. Lawmakers including Sens. Collins and Murkowski are pursuing bipartisan options, but GOP leadership resists and negotiations remain uncertain.
GOP Rebels Pressure Leaders as Enhanced ACA Subsidies Near Expiration
Rank-and-file Republicans in both chambers of Congress are intensifying pressure on GOP leaders to avert a potential spike in health-insurance premiums next year as enhanced Affordable Care Act (ACA) subsidies approach expiration. The dispute pits vulnerable moderates who fear voter backlash against conservatives who oppose measures perceived as supporting "Obamacare."
On Thursday, four Republican senators — Josh Hawley (R-Mo.), Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and Dan Sullivan (R-Alaska) — broke with party leadership and voted to advance a Democratic bill from Senate Minority Leader Chuck Schumer (D-N.Y.) that would extend the enhanced ACA premium subsidies for three years. The move signaled growing unease within the GOP conference despite efforts by Senate Majority Leader John Thune (R-S.D.) to maintain unity.
Pressure From the Right and the Center: The four senators also supported a competing Republican proposal to convert the value of the enhanced subsidies into contributions to health savings accounts (HSAs), a plan championed by Senate HELP Chair Bill Cassidy (R-La.) and Senate Finance Chair Mike Crapo (R-Idaho). That GOP alternative, however, received no Democratic votes during the floor proceedings.
Sen. Hawley warned that millions of working- and middle-class Americans could face dramatic premium increases if Congress does not act. "On our exchange, for folks in the 400 percent to 700 percent federal poverty band, we’re seeing 200%–300% increases — people are going to drop their insurance," he said.
One GOP senator, speaking anonymously, said senators were shown a slide during a recent briefing indicating that 88% of surveyed Americans view rising premiums as creating a national "health care crisis."
House Rebellion: Discharge Petitions and Bipartisan Bills
In the House, moderate Republicans from competitive districts have circulated discharge petitions to force floor votes on competing extension bills. Rep. Brian Fitzpatrick (R-Pa.) circulated a petition backed by 11 moderate and vulnerable Republicans and three Democrats to bring up his two-year extension proposal, co-sponsored by Rep. Jared Golden (D-Maine). That bill would extend the enhanced subsidies for two years while adding new eligibility rules and anti-fraud measures.
Separately, nine House Republicans joined a petition to force a vote on a Kiggans–Gottheimer (R/D) bill to extend enhanced subsidies for one year and impose income caps and additional fraud safeguards.
Speaker Mike Johnson (R-La.) has resisted discharge petitions, saying leadership generally opposes them. But many rank-and-file Republicans in swing districts say they fear political consequences if aid expires and premiums spike before the November elections.
Projections and Policy Stakes
Analysis from KFF projects that Americans receiving enhanced ACA tax credits would see their monthly premiums more than double if the subsidies expire in January. More broadly, ACA marketplace premiums are forecast to rise by about 26% on average next year.
Sens. Collins and Bernie Moreno this week unveiled a proposal to extend enhanced subsidies for two years while narrowing eligibility to households earning under $200,000 and requiring lower-income enrollees to contribute at least $25 per month. Collins said several Democratic senators privately indicated they were open to discussing the approach, and Senate Democratic Whip Dick Durbin (D-Ill.) called the Collins–Moreno plan a potential starting point for negotiations.
Independent Sen. Angus King (I-Maine), who caucuses with Democrats and helped schedule Thursday’s vote, said a bipartisan compromise combining an extension with income caps and anti-fraud reforms is conceivable — but would require overcoming entrenched GOP opposition to extending subsidies many conservatives blame for rising premiums.
On the Senate floor, Leader Thune argued that premiums under the ACA have risen sharply since 2013 and defended the GOP’s preference for reforms such as HSA contributions instead of a straight extension. Senate Democratic Whip Durbin, expressing skepticism about GOP willingness to reach a deal, quipped, "Republicans hate Obamacare like the devil hates holy water."
Outlook
The defection of senators and the surge of discharge petitions in the House underscore the political stakes as January approaches. With independent analyses predicting steep premium increases for many Americans, bipartisan pressure is building — but party leaders’ reluctance and internal GOP divisions make a timely compromise uncertain.
