House Republicans narrowly passed a major healthcare bill Wednesday as deep divisions erupted within GOP ranks over the future of Obamacare subsidies. The 216-211 vote delivered a hard-fought win for Speaker Mike Johnson but underscored fractures between conservative leadership and moderates on healthcare reform and fiscal discipline.
The legislation — dubbed the “Lower Health Care Premiums for All Americans Act” by GOP leaders — aims to lower average insurance costs by about 11 percent and impose new transparency rules on pharmacy benefit managers. Speaker Johnson and Republican leadership hailed the measure as a pro-market step toward reducing premiums and cutting red tape in the healthcare system.
The bill does not renew enhanced Obamacare premium tax credits, which were originally expanded during the COVID-19 pandemic and are set to expire December 31. Instead, GOP lawmakers plan to redirect focus toward expanding association health plans and other reforms that emphasize market competition and cost control.
That exclusion sparked a rebellion by four moderate Republicans — Reps. Brian Fitzpatrick, Mike Lawler, Rob Bresnahan, and Ryan Mackenzie — who joined Democrats in signing a discharge petition to force a vote early next year on extending Obamacare subsidies for three years. Their move illustrates mounting pressure on GOP leadership from members in swing districts concerned about rising premiums and potential coverage losses.
Conservative critics argue that continuing costly subsidies entrenches a failing system, and that subsidizing the Affordable Care Act only perpetuates dependency on federal support while failing to address price inflation. Supporters of Johnson’s approach say it lays groundwork for sustainable reform without adding new entitlements.
The Congressional Budget Office projects the Republican bill would reduce the federal deficit by roughly $35 billion over ten years while lowering premiums and saving taxpayer dollars. Opponents warn that without subsidy extensions, millions of Americans could face higher out-of-pocket costs or reduced coverage starting in 2026.
The Senate has not yet taken up the House bill, and its prospects remain uncertain as lawmakers return in the new year. Continued debate over healthcare policy is expected to shape Republican strategy ahead of the 2026 midterm elections.
