House Republicans Pass Healthcare Bill That Threatens Subsidies for 22 Million Americans

House Republicans on Wednesday passed a conservative healthcare package aimed at lowering costs without extending the expiring Obamacare subsidies, drawing a sharp contrast with Democrats ahead of next year’s midterm elections. The legislation, titled the Lower Health Care Premiums for All Americans Act, cleared the House on a largely party-line vote of 216-211.

Rep. Thomas Massie (R-Ky.) joined Democrats in opposing the measure. While the bill is unlikely to advance in the Senate, GOP leaders said the vote was meant to show Republicans are offering an alternative to propping up the Affordable Care Act. The legislation does not extend the enhanced tax credits set to expire on December 31—a change Democrats warn could affect roughly 22 million Americans.

Republicans counter that the subsidies benefit only a small portion of the population and fail to address rising healthcare costs overall. Instead, the GOP bill focuses on policies popular with conservatives, including funding for cost-sharing reductions, reforms to the powerful pharmacy benefit manager industry, and an expansion of association health plans, which allow small businesses and individuals to band together to purchase coverage at lower rates.

The nonpartisan Congressional Budget Office estimated that the bill would cut the federal deficit by $35.6 billion over 10 years through 2035. It also projected a slight reduction in insurance enrollment—about 100,000 people per year—while lowering benchmark premium costs by an average of 11% annually.

Despite the smooth floor vote, the issue has exposed divisions within the Republican conference. Speaker Mike Johnson (R-La.) has faced pressure from moderates in swing districts who favor extending the subsidies with changes. Talks between GOP leaders and centrists broke down this week, prompting four House Republicans to join Democrats in signing a discharge petition to force a vote on a three-year subsidy extension.

Rep. Mike Lawler (R-N.Y.), one of those Republicans, said leadership left moderates with few options. “I still believe a straight three-year extension is not the right policy,” he said, “but doing nothing is even worse.”

Republicans maintain their approach is about lowering premiums for all Americans, not just subsidizing Obamacare. Rep. August Pfluger (R-Texas) stated: “Democrats are worried about 6% of our country. Republicans are worried about 100%.”