众议院周四以230比196的投票结果通过了一项法案，将患者保护与平价医疗法案增加的补贴延长三年，17名共和党人与民主党人一起投票，无视共和党领导人。
在投票之前，民主党人吹嘘说，几名共和党人预计会违抗他们的领导团队。
一条切实可行的前进道路，即通过参议院将立法提交给Resolute Desk，以解决过期补贴问题，仍是一个问题。
参议院多数党领袖约翰·图恩(John Thune)周四表示，上议院“没有兴趣”延期，而是指出参议员和众议院成员之间正在进行的两党谈判。
“如你所知，我们已经投票了，”图恩说。“但我们将看看工作组会发生什么，他们是否能拿出一些改革的东西。我们从那里开始。
众议院少数党领袖哈基姆·杰弗里斯(Hakeem Jeffries)对周四投票前建立的“两党联盟”表示自豪，该投票是在九名共和党人之后进行的，旨在将《强化平价医疗法案》(enhanced Affordable Care Act)补贴延长三年穿过过道周三晚上在房子里设置通道。
“我希望今天会有更多的共和党人加入这一领导人，”参议院少数党领袖查克·舒默在周四的新闻发布会上指着杰弗里斯说。
杰弗里斯称这次投票是“一个向前迈出有意义的一步的机会，以降低美国人日常生活的高成本，特别是在医疗保健方面，但这是一场我们将代表美国人民继续进行的战斗。”
周三的程序性投票以221比205的优势通过，九名共和党人与民主党人一起投票通过。
这些补贴将于2025年底到期，在新冠肺炎疫情期间得到加强，以增加对已经有资格的人的财政援助金额，并将资格扩大到更多人。
一个由众议院议员和参议员组成的两党小组周四在午餐时间进行了约一个小时的会晤，以努力解决各种医疗保健条款，随后告诉记者，他们已经达成协议，解决普遍存在的欺诈问题，如虚假账户。
新罕布什尔州民主党参议员珍妮·沙欣(Jeanne Shaheen)在离开会议时告诉记者:“我们正在努力看看我们是否能达成一些协议，这将有助于他们，我们越早这样做越好。”"因此，大家一致同意解决欺诈问题."
沙欣没有透露即将达成的交易的细节，但表示下一步将在未来几天内起草法案文本。
许多保守派希望增加海德修正案保护措施，以确保ACA税收抵免的延长不会为堕胎服务提供联邦资金，从而引发民主党对共和党提议的反对。
但包括众议员唐·培根(Don Bacon)和丹·默瑟(Dan Meuser)在内的几位温和派人士承认，ACA已经包括了海德保护措施，因此在拨款者之间存在一场持续的辩论，即如果延长补贴没有明确规定这些保护措施，这是否足以保护保守派。
尽管如此，一些共和党人认为两党达成协议指日可待。
“事情仍在解决中。总是有细节——所谓的细节中的魔鬼，或者也许是细节中的天使，”默瑟说，并补充说立法者希望“尽快”结束讨论
“我的意思是，至少可以说，这的确是一种紧迫感，”他说。
立法者没有透露他们是否安排了另一次会议，但暗示法案文本可能很快准备好。
“他们非常接近，”共和党众议员布赖恩·菲茨帕特里克说，并补充说，该法案反映了他和劳勒以及民主党众议员汤姆·索兹和贾里德·戈尔登提出的一项法案的语言。
Suozzi说，“当你参加这样的会议时，这是一种非常有希望的感觉”，他在会上提到了民主党人和共和党人的平分秋色，同时强调每个人都致力于“超越这种毒性，并试图找到一些共同点。”
上个月，参议院否决了将补贴延长三年的提议，因为该措施未能达到60票的门槛，尽管四名共和党人——缅因州参议员苏珊·科林斯、密苏里州参议员乔希·霍利、阿拉斯加州参议员莉萨·穆尔科斯基和丹·沙利文——都支持该措施。
在2400万ACA市场注册者中，估计有2200万人目前正在接受增强的保费税收抵免，以降低他们的每月保费，许多人看到他们的保费在2026年飙升。
无党派的国会预算办公室估计，该法案将在未来十年增加约806亿美元的联邦赤字。
据《CBO》报道，如果该措施得以实施，与现行法律相比，2026年拥有医疗保险的人数将增加10万人，2027年增加300万人，2028年增加400万人，2029年增加110万人。
根据CBO的说法，2028年增加的400万人将来自几种保险类型的变化:将有620万人通过ACA健康保险市场注册;参加医疗补助和儿童健康保险计划的人数增加了400，000万;在市场之外购买非团体保险的人会减少50万;将有210万人享受基于就业的保险。
唐纳德·特朗普总统公开表示反对延长增加的补贴。
“我希望不能够做到这一点。我想看到我们进入正题。特朗普12月18日在椭圆形办公室说:“我不知道我们为什么必须延长——如果民主党人愿意，这可以很快完成。”。
去年年底，在议长迈克·约翰逊顶住压力，允许就补贴进行投票后，众议院共和党人的四人组-菲茨帕特里克，劳勒，布雷斯纳汉和麦肯齐-在假期前联合起来，签署了一份民主党出院请愿书，以迫使就ACA延期进行投票，这让共和党领导人非常懊恼。
17 House Republicans vote with Democrats to extend Obamacare subsidies for 3 years
The House passed a bill on Thursday to extend the Affordable Care Act enhanced subsidies for three years by a vote of 230-196 with 17 Republicans voting with Democrats and defying GOP leaders.
Ahead of the vote, Democrats boasted that several Republicans were expected to defy their leadership team.
A tangible path forward that sends legislation through the Senate to the Resolute Desk to address the expired subsidies remains in question.
Senate Majority Leader John Thune said Thursday that there's "no appetite" for an extension in the upper chamber and pointed instead to ongoing bipartisan talks between senators and House members.
"We've had that vote, as you know, already," Thune said. "But we'll see what happens from the working group, and if they can come up with something that has reforms. And we'll go from there.
House Minority Leader Hakeem Jeffries expressed pride in the "bipartisan coalition" created ahead of Thursday's vote on a three-year extension of enhanced Affordable Care Act subsidies after nine Republicanscrossed the aisleWednesday night to set up passage in the House.
"I hope today there will be more Republicans joining this leader," said Senate Minority Leader Chuck Schumer, gesturing towards Jeffries at a news conference Thursday.
Jeffries called the vote "an opportunity to take a meaningful step forward to lower the high cost of living for everyday Americans, particularly as it relates to health care, but it's a battle that we will continue to wage on behalf of the American people."
Wednesday's procedural vote passed by a 221-205 margin with nine Republicans voting with Democrats to pass it.
The subsidies, which expired at the end of 2025, were enhanced during the COVID-19 pandemic to increase the amount of financial assistance to those who were already eligible and to expand eligibility to more people.
A bipartisan group of House members and senators met for about an hour over lunch Thursday to grapple over various health care provisions, telling reporters afterward that they've struck an agreement to address widespread fraud, such as phantom accounts.
"We're trying to see if we can get to some agreement that's going to help them, and the sooner we can do that, the better," New Hampshire Democratic Sen. Jeanne Shaheen told reporters as she left the meeting. "So there was agreement on addressing fraud."
Shaheen did not divulge details of an impending deal but said the next step will be crafting bill text in the coming days.
Many conservatives want to add Hyde Amendment protections to ensure that an extension of the ACA tax credits won't provide federal funds for abortion services, generating Democratic opposition to GOP proposals.
But several moderates, including Reps. Don Bacon and Dan Meuser, conceded that the ACA already includes Hyde protections, so there is an ongoing debate among appropriators on whether that's sufficient cover for conservatives if an extension of the subsidies does not explicitly codify those protections.
Nevertheless, some Republicans believe a bipartisan deal is within reach.
"Things are still being hashed out. There's always the details -- the so-called devil's in the details, or maybe the angel's in the details," Meuser said, adding lawmakers hope to conclude discussions "as soon as possible."
"I mean, it's certainly a sense of urgency, to say the least," he said.
Lawmakers did not reveal whether they scheduled another meeting but signaled that bill text could be ready soon.
"They're very close," said GOP Rep. Brian Fitzpatrick, adding that the bill mirrors the language of a bill that he and Lawler and Democratic Reps. Tom Suozzi and Jared Golden introduced.
Suozzi said it was "a very hopeful feeling when you participate in a meeting like this," citing an even split of Democrats and Republicans at the meeting while emphasizing everyone's commitment to "moving beyond this toxicity and trying to find some common ground."
The Senate last month rejected a three-year extension of the subsidies when the measure fell short of the 60-vote threshold, though four Republicans -- Sens. Susan Collins of Maine, Josh Hawley of Missouri, and Lisa Murkowski and Dan Sullivan of Alaska -- all crossed the aisle in support of the measure.
An estimated 22 million of the 24 million ACA marketplace enrollees are currently receiving enhanced premium tax credits to lower their monthly premiums, and many are seeing their premiums soar in 2026.
The nonpartisan Congressional Budget Office estimates the bill would increase the federal deficit by about $80.6 billion over the next decade.
If the measure is enacted, the number of people with health insurance would increase by 100,000 people in 2026, 3 million in 2027, 4 million in 2028 and 1.1 million in 2029, relative to current law, the CBO reported.
According to the CBO, the 4 million increase in 2028 would result from changes in several types of coverage: 6.2 million more people would be enrolled through ACA health insurance marketplaces; 400,000 million more people enrolled in Medicaid and the Children's Health Insurance Program; 500,000 fewer people would purchase nongroup coverage outside the marketplaces; and 2.1 million fewer people would have employment-based coverage.
President Donald Trump has publicly expressed his opposition to extending the enhanced subsidies.
"I'd like not to be able to do it. I'd like to see us get right into this. I don't know why we have to extend -- this can be done rapidly if the Democrats would come along," Trump said on Dec. 18 in the Oval Office.
After Speaker Mike Johnson resisted pressure to allow a vote on the subsidies late last year, a quartet of House Republicans -- Fitzpatrick, Lawler, Bresnahan and Mackenzie -- banded together before the holiday break and signed on to a Democratic discharge petition to force a vote on an ACA extension, much to the chagrin of GOP leaders.
