The failure of GOP leadership and moderates to agree on extending Affordable Care Act premium subsidies prompted four Republican moderates to join Democrats in a bid to protect roughly 24 million Americans from higher insurance costs set to begin Jan. 1. The House passed a partisan alternative that delays many changes until 2027, while the bipartisan three-year extension backed by moderates has stalled in the Senate. The dispute heightens reelection risks in about three dozen competitive districts and could determine control of the narrowly held 220-213 House majority.
GOP Moderates Break Ranks to Protect 24M From ACA Premium Hikes, Threatening Narrow House Majority
Member of the Republican Party Rob Bresnahan speaks during a campaign rally of Republican presidential nominee and former U.S. President Donald Trump in Wilkes-Barre, Pennsylvania, U.S. August 17, 2024. REUTERS/Jeenah Moon
WASHINGTON, Dec 19 (Reuters) - Concern among House Republicans about losing their slim majority boiled over this week when four moderate GOP members joined Democrats in a last-ditch effort to avert a sharp rise in healthcare costs for roughly 24 million Americans beginning in less than two weeks.
The group — which includes Representatives Rob Bresnahan, Brian Fitzpatrick and Ryan Mackenzie of Pennsylvania, and Mike Lawler of New York — is part of a broader cohort of about a dozen House Republicans who had pushed for a bipartisan stopgap to extend Affordable Care Act (ACA) premium subsidies set to expire after Dec. 31.
Those moderates hold a small but pivotal slice of the House: they represent many of the roughly three dozen of the 435 seats expected to be competitive in next November's midterm elections and could determine whether Republicans keep their 220-213 majority.
Negotiations Collapse Over Conservative Conditions
Negotiations with Republican leadership collapsed after leaders proposed conservative restrictions that moderates said were unacceptable. Frustrated, the four joined Democrats to force a vote on a clean, three-year extension backed by House Democratic Leader Hakeem Jeffries.
"We wanted an up-or-down vote," said Rep. Mike Lawler, who is locked in a toss-up race in a district north of New York City. "Unfortunately, leadership found every way not to let that happen. And so, we were left with no choice but to sign the clean three-year (Democratic) extension and force a vote."
The three-year extension measure approved by moderates passed the House but has already failed in the Senate. Moderates had hoped that a clear House vote would spur a bipartisan compromise to clear both chambers and blunt the premium increases analysts warn are imminent. With talks stalled, there is no guarantee of a deal in time to prevent higher costs that are expected to begin on Jan. 1.
Partisan Alternative and Political Stakes
Instead of the bipartisan extension, the House passed a partisan healthcare bill intended to lower premiums for some while reducing overall subsidies and raising costs for others, with many changes delayed until January 2027 — two months after the next election. Speaker Mike Johnson said he had tried to give moderates a vote and rejected the notion that moderates would be uniquely vulnerable at the ballot box.
"These are extraordinary people. They know how to run campaigns, and they're going to have a great record to run on," Johnson told Reuters, adding that Republicans plan to pursue more legislation aimed at lowering healthcare costs next year.
Analysts say the dispute raises significant risks for Republicans. "In the event of a Blue wave next year, the members in the competitive seats are the ones who are going to pay the price, even if they're the ones who want to restore these Obamacare subsidies," said Kyle Kondik of the University of Virginia Center for Politics. Moderates, he added, want to be able to go on record voting to protect subsidies.
Democrats view rising healthcare costs as a potent campaign issue and plan to use Republican inaction on ACA subsidies as a central message about affordability. Former Rep. Charlie Dent, now at the Aspen Institute, said the combination of Medicaid changes from recent fiscal legislation and pending premium spikes could be "a more potent issue than was the case in 2018."
Outlook
With a narrow 220-213 majority, Republicans can lose no more than three seats and still retain control of the House. They face more than a dozen toss-up races and additional vulnerable contests where Democrats could score upsets. Democrats express confidence about regaining the chamber next year, while Republicans aim to counter with targeted strategies including redistricting in states they control.
"They're going to lose the House. Hakeem Jeffries will be speaker," said Rep. Nancy Pelosi, referring to Democrats' expectations that healthcare and affordability will drive voters.
(Reporting by David Morgan; editing by Scott Malone and Alistair Bell)
