Speaker Mike Johnson on Tuesday shut the door on a vote to extend Affordable Care Act subsidies that are set to expire at the end of the year, bucking moderates in his party who had urged action to prevent millions of Americans from facing higher health care costs starting Jan. 1.
Though Mr. Johnson had signaled openness to allowing debate on the proposal, he ultimately rejected a bid to do so by politically vulnerable Republicans who had hoped for a vote that would, at the very least, allow them to show voters they had tried to avoid rising premiums.
Instead, the House is set on Wednesday to consider a narrow G.O.P. health care plan that would allow Obamacare subsidies beefed up during the pandemic to expire and make several small changes aimed at bringing down costs over the long term.
The speaker’s decision came after a day of waffling that reflected the deep disarray in G.O.P. ranks over how to address rising health care costs, an issue that Democrats have promised to make a centerpiece of their midterm election campaigns.
Most Republicans are vehemently opposed to the Affordable Care Act, which was fully implemented in 2014 during the Obama administration, but they have been unable to coalesce around a plan to replace it. A small group of Republicans from swing districts, alarmed about the political consequences of allowing the subsidies to expire, had been urging Mr. Johnson to allow a vote on allowing them to continue at some level, at least temporarily.
After a closed-door morning meeting with Republicans, Mr. Johnson ruled out holding such a vote.
“We looked for a way to try to allow for that pressure release valve, and it just was not to be,” Mr. Johnson told reporters.
That drew fury from the small group of politically vulnerable Republicans who had been pressing for such a vote.
“It’s idiotic,” Representative Mike Lawler of New York, who represents a suburban swing district, told reporters, adding that the decision was “political malpractice.”
Later, after meeting with Mr. Lawler and other Republicans backing a subsidy extension, Mr. Johnson said a vote was still possible. But by the evening, the powerful Rules Committee, which is controlled by the speaker and determines what legislation reaches the floor, rejected the moderates’ proposal.
That left open the question of whether Mr. Johnson, whose razor-thin majority allows for only a few defections, would even have the votes on Wednesday to bring up the narrow health care measure that Republicans have put forward.
The fate of the subsidies was all but sealed last week, after the Senate deadlocked on competing Democratic and Republican proposals to extend them. With lawmakers expecting to depart Washington at the end of this week, there was little time left to preserve them.
Then on Friday, Mr. Johnson released a limited health care bill that did not address the subsidies. The moderates’ proposal to extend them had been expected to be brought to the floor as an amendment to that measure.
But on Tuesday morning, Mr. Johnson said that Republicans had been discussing the details of the extension proposal, including how to pay for it and whether it should be subject to abortion restrictions, and could not reach a deal to allow the vote to proceed.
The moderates have maintained that G.O.P. leaders’ package would not do enough to address rising premiums. The bill includes policies that would allow small businesses to band together to buy insurance; new regulations on pharmacy benefit managers, companies that act as intermediaries to help health plans administer prescription drug benefits; and the restoration of payments to health insurers that President Trump canceled during his first term.
According to the Congressional Budget Office, a nonpartisan agency, the legislation could lead to 100,000 more Americans becoming uninsured by 2035 and would reduce the federal deficit by $35.6 billion.
The office has also predicted that around two million more Americans would become uninsured next year if the Affordable Care Act subsidies were not extended, and 3.8 million over a decade.
With their leaders refusing to act, some Republicans have resorted to trying to go around them. There are two separate discharge petitions that would force a vote on legislation extending the subsidies while trimming them.
But both would need the support of 218 members of the House to succeed. Democrats have instead been circulating a petition to force a vote on their plan to extend the subsidies in full for three years, but they would need the backing of at least a handful of Republicans. Even if any of those measures were to draw sufficient support this week, they could not come to the floor before the end of the year, when the subsidies expire.
In the Senate, lawmakers were already looking toward next year. Senator John Thune, Republican of South Dakota and the majority leader, told reporters that “there is a potential pathway in January if Democrats are willing to come to the table with things that actually will drive down the cost of health care.”
A bipartisan group of about 20 senators met on Monday night to see whether they could find agreement on a way forward on the subsidies, with an eye toward trying to advance legislation next month.
Organizers of the group said there appeared to be an early consensus to extend the tax credits for two years, scaling them back during the second. The group hoped to issue a legislative framework before leaving for the holidays.
“This was a very constructive meeting,” said Senator Susan Collins, Republican of Maine and one of those who put the meeting together. She said the group was united in trying to “prevent huge spikes in insurance premiums that will make insurance unaffordable for lower and middle-income Americans.”
Ms. Collins added: “The fact that the enhanced premium tax credits are going to expire hits hard.”
Michael Gold covers Congress for The Times, with a focus on immigration policy and congressional oversight.
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