4 Republicans defy Speaker Johnson to force House vote on extending ACA subsidies

WASHINGTON (AP) — Four centrist Republicans broke with Speaker Mike Johnson on Wednesday and signed onto a Democratic-led petition that will force a House vote on extending for three years an enhanced pandemic-era subsidy that lowers health insurance costs for millions of Americans.

The stunning move comes the same day House Republican leaders pushed ahead with a health care bill that does not address the soaring monthly premiums that millions of people will soon endure when the tax credits for those who buy insurance through the Affordable Care Act expire at year’s end.

The action sets the stage for a renewed intraparty clash over health care in January, something Republican leaders had been working to avoid, just weeks before another government funding deadline at the end of that month.

The moderate Republicans were able to force the issue by signing a petition, led by Democratic leader Hakeem Jeffries of New York, to vote on a bill that would extend the ACA subsides for three years.

Republican Reps. Brian Fitzpatrick, Robert Bresnahan and Ryan Mackenzie, all from Pennsylvania, and Mike Lawler of New York signed on Wednesday morning, pushing it to the magic number of 218. A vote on the subsidy bill could come as soon as January under House rules.

“Unfortunately, it is House leadership themselves that have forced this outcome.” Fitzpatrick said in a statement.

Johnson told reporters Wednesday that “I have not lost control of the House” and he noted that Republicans have a razor-thin majority that allows a small number of members to employ procedures that would not usually be successful in getting around leadership.

“These are not normal times,” said Johnson, R-La.

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Origins of a Republican revolt

The revolt against GOP leadership came after days of talks centered on the health care subsidies.

Johnson had discussed allowing more politically vulnerable GOP lawmakers a chance to vote on bills that would temporarily extend the subsidies while also adding changes such as income caps for beneficiaries. But after days of discussions, the leadership sided with the more conservative wing of the party's conference, which has assailed the subsidies as propping up a failed ACA program, which is widely known as “Obamacare.”

Fitzpatrick and Lawler tried to add a temporary extension of the subsidies to the bill, but were denied.

“Our only request was a floor vote on this compromise, so that the American People’s voice could be heard on this issue. That request was rejected. Then, at the request of House leadership I, along with my colleagues, filed multiple amendments, and testified at length to those amendments,” Fitzpatrick said. “House leadership then decided to reject every single one of these amendments."

Lawler, in a social media post, similarly said that “the failure of leadership” to permit a vote had left him with “no choice” but to sign the petition.

Jeffries, for several weeks, had called on Republicans to sign his discharge petition. He particularly challenged Republicans in competitive congressional districts to join the effort if they really wanted to prevent steep premium increases for their constituents.

The GOP holds a 220-213 majority in the House, which means defections from just a sliver of the conference can upend leadership's plans. Johnson has been able to negotiate that challenge largely by making accommodations to the more conservative wing of his conference. This time, it was the moderates who revolted.

Iowa delegation supports Republican bill

House Republicans pushed ahead Wednesday on a 100-plus-page health care package without the subsidies. Instead, the measure focused on long-sought GOP proposals designed to expand insurance coverage options for small businesses and the self-employed. The bill passed on a mostly party-line vote of 216-211. Rep. Thomas Massie, R-Ky., joined with Democrats in voting against the measure.

Every member of Iowa’s all-Republican U.S. House delegation voted for the bill. Among them was U.S. Rep. Zach Nunn of Bondurant, who earlier this year signed on as a co-sponsor of a bipartisan proposal to extend the enhanced Affordable Care Act premium tax credits for two years while adding new income limits and anti-fraud penalties.

U.S. Rep. Mariannette Miller-Meeks of Ottumwa, who introduced the bill, and House GOP leaders argued the Republican bill would lower insurance premiums nationwide and rein in costs they blame on the Affordable Care Act.

In a joint statement after House passage, Miller-Meeks, Speaker Johnson and other GOP leaders said the “Lower Health Care Premiums for All Americans Act” would lower premiums for all Americans and save taxpayers $30 billion in the process.

Miller-Meeks has said the bill gives consumers more flexibility in choosing health plans that fit their needs, lowers costs more broadly than the temporary, pandemic-era premium subsidies enacted by Democrats, and increases transparency in the health care system.

U.S. Rep. Randy Feenstra of Hull echoed that message.

“Iowans are paying too much for routine checkups and prescription drugs and traveling long distances for doctor’s appointments and emergency care. It’s unsustainable and must change,” Feenstra said in a statement. “That’s why I voted to lower healthcare premiums for Iowa families, seniors, veterans, and small businesses, expand access to high-quality care in rural areas, and ensure transparency in healthcare pricing.”

A nonpartisan Congressional Budget Office estimate released Tuesday found the proposal would reduce the federal deficit by about $35.6 billion over the next decade and lower benchmark marketplace premiums by an average of 11 percent from 2027 to 2035, while also slightly increasing the number of uninsured Americans. CBO projected an average of 100,000 more people would be uninsured over that period and estimated association health plan enrollment would rise by about 700,000 people per year through 2035, including about 200,000 people who were previously uninsured.

House Democrats cautioned that reducing premium tax credits could push more consumers into skimpier coverage with higher deductibles and cost-sharing, and warned the approach could weaken protections for people with preexisting conditions — criticism Republicans dispute.

Path ahead is uncertain

Even if the Democrats' subsidy bill were to pass the House in January, which is far from assured, it would face an arduous climb in the Republican-led Senate.

Republicans last week voted down a three-year extension of the subsidies and proposed an alternative that also failed. But in an encouraging sign for Democrats, four Republican senators crossed party lines to support their proposal.

Senate Majority Leader John Thune, R-S.D., argued against the Democratic extension as “an attempt to disguise the real impact of Obamacare’s spiraling health care costs.”

Sen. Thom Tillis, R-N.C., said he viewed the House developments Wednesday as a positive for generating a compromise that both parties could support.

“If we're not talking, we're not making progress. This continues the discussion,” Tillis said.

Senate Democratic leader Chuck Schumer of New York said that the 218th signature for the Democrats' bill showed that the demand from the American people for an extension is undeniable, but “the damage has now been done, no matter what happens.”

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Tom Barton of The Gazette contributed to this report.