House passes ACA subsidies extension in dramatic vote

Seventeen House Republicans joined the chamber's Democrats on Thursday in voting to revive enhanced Affordable Care Act subsidies for three years. Why it matters: The dramatic 230-196 vote marked a rare rebuke by some Republicans of their own leadership, driven by concerns about spiking health care costs in an election year dominated by affordability concerns. While the subsidy extension is expected to die in the Senate, the vote does put pressure on the upper chamber to try to come to a bipartisan agreement that likely would include GOP-backed changes to the aid. Driving the news: The House approved a "clean" three-year extension of the subsidies, without any changes. The effort, led by Minority Leader Hakeem Jeffries (D-N.Y.), came to a vote after four House Republicans in December signed a Democratic discharge petition to force the matter, going around Speaker Mike Johnson (R-La.). GOP leadership opposes the extension of the subsidies, arguing they are wasteful spending that benefits insurance companies. While a bipartisan group of senators is discussing a compromise measure that could include new limits on the subsidies like eliminating $0 premiums, Democratic leaders in the upper chamber are still pushing for the clean extension. Between the lines: President Trump has not been heavily engaged in the congressional discussions, leaving Republicans on the hill to try to work out their differences without much guidance from the White House. Trump this week did tell House Republicans to be "flexible" on the Hyde Amendment, which limits taxpayer funding of abortion, but many Republicans are still insisting on the limits being attached to the subsidies. By the numbers: The Congressional Budget Office said Thursday that the three-year extension would increase the deficit by $80.6 billion over a decade. It would also lead to four million more people with health coverage in 2028. KFF previously projected that without an extension, out of pocket premium costs would more than double, increasing an average of 114% for ACA enrollees.