A growing divide inside the Republican Party burst into public view on Wednesday as a coalition of GOP moderates launched a rare procedural effort to force a House vote on extending Affordable Care Act subsidies set to expire at the end of the year. The move directly confronts Speaker Mike Johnson and underscores the political pressure surrounding health-care policy heading into the 2026 midterm elections.
Rep. Brian Fitzpatrick of Pennsylvania, backed by several Republicans from competitive districts, filed a discharge petition aimed at bringing a bipartisan two-year extension bill to the House floor. A second petition – focused on a one-year extension – was simultaneously introduced by Democratic Rep. Josh Gottheimer of New Jersey and Republican Rep. Jen Kiggans of Virginia. Either petition would need 218 signatures to succeed, bypassing leadership and compelling a vote.
The bipartisan Fitzpatrick-Golden proposal calls for extending the enhanced premium tax credits through 2027, adding an income-based eligibility cap, expanding health savings account access, and introducing a modest monthly contribution from low-income beneficiaries to deter fraud. The subsidies, originally boosted during the pandemic, currently help more than 20 million Americans afford marketplace coverage. If they lapse on December 31, experts warn that many enrollees could see substantial premium increases.
Speaker Johnson, however, has dismissed the possibility of bringing any subsidy extension to the floor under normal procedure, citing the unofficial “Hastert rule,” which encourages speakers to advance only bills backed by most of the majority party. GOP leaders instead plan to move forward with a health-care package they say all Republicans can support. That package centers on expanding HSAs, adjusting association health plans, increasing transparency measures, and targeting pharmacy benefit managers – but it excludes any continuation of the ACA subsidies.
Behind closed doors, tensions escalated during a lengthy Wednesday morning conference meeting. Moderates such as Reps. Kevin Kiley of California and Mike Lawler of New York warned that failing to address what they described as a looming “health-care cliff” could severely damage the party in tight midterm races. Conservatives pushed back sharply: Rep. Andy Harris of Maryland insisted he would only consider extending subsidies if the package included Hyde Amendment-style restrictions, while Rep. Ralph Norman of South Carolina argued the pandemic-era assistance should end altogether.
Several Republicans representing swing districts voiced concerns that allowing subsidies to expire would be politically devastating. Rep. John Rutherford of Florida cautioned that the party risked “fumbling the health-care ball,” while Rep. Jeff Van Drew of New Jersey predicted potential electoral fallout if millions face sudden cost increases.
Even if moderates secure enough signatures, procedural hurdles remain steep. House rules require at least seven legislative days before a petition can be brought to the floor, and only six working days are left before the year ends. Democratic support – which would be nearly essential – is also not guaranteed, as Minority Leader Hakeem Jeffries is backing a separate three-year clean extension.
Across the Capitol, the Senate is scheduled to vote Thursday on competing proposals: a Republican plan to replace subsidies with federally funded HSAs for high-deductible plans, and a Democratic plan offering a three-year extension without added reforms. Neither measure is expected to clear the chamber.
President Donald Trump has yet to take a definitive position, stating only that he prefers assistance to go “directly to the people.”
House Republicans say they will unveil their official approach to the issue next week, with only days remaining before the scheduled December 18 adjournment and the expiration of the subsidies.
