U.S. Rep. Marie Gluesenkamp Perez, D-Skamania, joined breakaway Republicans and all House Democrats on Thursday in voting to renew Affordable Care Act (ACA) subsidies that expired at the end of 2025.
The U.S. House of Representatives forced a vote on the bill. If approved by the Senate and signed into law, the legislation would extend the subsidies for three years. It's unlikely the bill will receive the necessary support in the U.S. Senate without considerable changes.
Gluesenkamp Perez was one of the 230 members of the House to approve the bill, along with 17 House Republicans who broke with their party. A total of 196 Republicans voted against the measure.
All Democrat members of Washington state's congressional delegation voted in favor of the bill while both Washington state Republican members of Congress voted against it.
The unlikely coalition passed the subsidies against the wishes of House leadership by using a discharge petition, which can force a vote on a bill without the approval of chamber leadership.
Shortly after the vote, Gluesenkamp Perez released a statement clarifying her stance on the subsidies that she voted to approve.
“Nearly 25,000 Southwest Washingtonians have been dealing with skyrocketing health care costs since the enhanced ACA subsidies expired at the end of last year,” Gluesenkamp Perez said. “I voted for the three-year extension to help give them some relief.”
At the same time, the congresswoman shared critiques of the ACA subsidies. In the statement, Gluesenkamp Perez said she and her colleagues needed to institute policy reform to bring down health care costs and lower the cost for the government to provide subsidies in the future.
“Congress is a habit-forming body,” Gluesenkamp Perez said in her statement. “If we continue blindly extending subsidies to the big insurers without moving to increase supply and make the system more competitive, then we’ll get stuck in a doom-spiral of ever-increasing costs and taxpayers will get stuck with the tab.”
House GOP leaders didn’t want to bring the bill up in their chamber, but a handful of their own members signed the discharge petition in December, forcing the vote amid rising health care costs.
Massachusetts Democratic Rep. Jim McGovern said during floor debate on Wednesday evening “it’s about damn time” the chamber took up a bill to address the now-expired tax credits, arguing lawmakers have a “moral obligation to act” to help people afford health insurance.
“This Congress musters up the will to spend trillions of dollars on tax breaks for billionaires and to send the Pentagon billions of dollars more than they even asked for. And the administration came up with tens of billions of dollars to bail out Argentina, for God’s sake,” McGovern said. “But somehow helping moms and dads, grandparents and kids afford trips to the doctor is a step too far for this Republican leadership.”
New York GOP Rep. Mike Lawler said he only backed the bill after Republican leaders declined to bring up a bipartisan two-year compromise bill he helped negotiate last year.
“I am voting in favor of this discharge and of this legislation to send it to the Senate so that the Senate will have the opportunity to put forth a reform package that can pass Congress and become law,” Lawler said.
Republicans and Democrats, he said, agree that the country’s health care system is in need of a serious overhaul. He called on his colleagues to find solutions to the bigger, more structural issues.
“Enough of the blame game on both sides,” Lawler said. “Let’s focus on actually delivering affordable health care for Americans.”
Democrats originally established the enhanced ACA marketplace tax credits during the coronavirus pandemic in an attempt to get more people health insurance coverage. They set the subsidies to expire at the end of 2025.
The debate over the sunset date simmered in the background for much of last year but surged to the forefront in October after Democrats shut down the government and repeatedly demanded GOP leaders negotiate an extension to the expiring enhanced tax credits.
The shutdown ended in mid-November after Senate Majority Leader John Thune, R-S.D., agreed to give Democrats a vote on a health care bill of their choosing in December.
Senate Minority Leader Chuck Schumer, D-N.Y., ultimately decided to bring up a three-year extension of the enhanced tax credits without any changes, but it failed to get the 60 votes needed to advance.
A proposal from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo, both Republicans, that would have provided funding through Health Savings Accounts for some ACA marketplace enrollees during 2026 and 2027 also failed to move toward final passage.
A House Republican health care bill passed that chamber last month, but doesn’t have the bipartisan support to move through the Senate and become law.
Thune said Tuesday any renewal of the enhanced ACA marketplace subsidies would need reforms to move through that chamber.
The bill, he said, would need to set income limits on who qualifies for the enhanced tax credit and eliminate ACA health insurance plans that have $0 premiums, a feature Republicans allege allowed insurance companies to enroll people without their knowledge to receive the subsidy.
“And then the second component would be some sort of a bridge to (Health Savings Accounts). An expansion of HSAs so that you’re getting more money into the pockets of the American people, the patients, if you will, the consumers, as opposed to insurance companies,” Thune said. “And then finally you’ve got to deal with the Hyde issue.”
The Hyde Amendment has been a feature of government spending bills for decades, preventing federal dollars from going to abortions unless the pregnancy is the result of rape, or incest, or threatens the woman’s life.
Republicans want the prohibition to apply to all ACA marketplace health insurance plans without any way for Americans to pay for the coverage themselves, the way they do now. Democrats have rejected the change as a non-starter that would restrict abortion access in blue states.
President Donald Trump waded into that debate this week, telling House Republicans during a policy retreat at the Kennedy Center they must be “flexible” about the Hyde Amendment in order to broker a health care deal that can reach his desk.
“You have to be a little flexible on Hyde. You know that. You’ve got to be a little flexible,” Trump said. “You’ve got to work something. You’ve got to use ingenuity. You’ve got to work. We’re all big fans of everything, but you’ve got to have flexibility.”
Susan B. Anthony Pro-Life America President Marjorie Dannenfelser rebuked Trump for the comment, writing in a statement that to “suggest Republicans should be ‘flexible’ is an abandonment of this decades-long commitment. If Republicans abandon Hyde, they are sure to lose this November.”
States have a patchwork of laws addressing abortion coverage in ACA marketplace health insurance plans, with 25 prohibiting coverage with certain exceptions and 12 requiring abortion coverage, according to analysis from the nonpartisan health research organization KFF.
“In states that do not bar coverage of abortions on plans available through the Marketplace, insurers may offer a plan that covers abortions beyond the permissible Hyde amendment situations when the pregnancy is a result of rape, or incest or the pregnant person’s life is endangered, but this coverage cannot be paid with federal dollars.”
Any ACA marketplace health insurance plan that offers abortion coverage in circumstances outside those three exceptions must charge each enrollee $1 for that coverage, according to KFF.
A bipartisan group of senators has been talking behind the scenes for months about how to extend the ACA marketplace subsidies with changes.
Ohio Republican Sen. Bernie Moreno said Thursday he expects the group, which has agreed on a “framework,” to release a bill next week, though he cautioned that’s just one small step.
“We have agreement that we think we have a skeleton of a deal. But it’s all fun and games until you have it on paper in a bill form,” Moreno said. “So we have to do that. And then we have to go sell the heck out of it to our conference. And again, look, this is politics. There’s people on both sides that want this to fail. So we have to get past that massive mountain.”
