The Republican-controlled Senate has already rejected a similar bill, but House passage could spur a compromise.

Senate negotiators are weighing proposals that would extend the subsidies for less than three years, limit coverage to people below a certain income level, and soften abortion limits sought by conservatives.

The House voted 230-196 to approve the measure, with 17 Republicans joining Democrats, who cheered on its passage.

Opinion polls show “affordability” is a top voter concern, and lawmakers are looking to take action to limit price increases ahead of the November elections that will determine control of Congress.

“Democrats are going to make healthcare and the high cost of living the number one issue for all of 2026,” Senate Democratic Leader Chuck Schumer said at a press conference.

Congress allowed tax breaks that had benefited 24 million Americans who get their coverage through the Affordable Care Act to expire at the end of 2025.

Restoring those subsidies would lead to 6.2 million more people enrolled in the program and cost the government $80.6 billion over 10 years, according to the nonpartisan Congressional Budget Office.

The Affordable Care Act, nicknamed “Obamacare,” became law in 2010 over Republican opposition and the subsidies were passed in 2021 in response to the COVID-19 pandemic without any Republican votes.

The House vote amounts to a striking victory for Democrats, who triggered a record 43-day government shutdown last autumn in an unsuccessful effort to extend the subsidies, and a rebuke to House Speaker Mike Johnson.

Americans have until January 15 to enrol in ACA coverage for this year, although the Trump administration could extend that deadline.

Democratic Representative Jim McGovern of Massachusetts said some of his constituents were facing thousands of dollars in higher monthly costs due to Washington’s failure to enact a fix.

Republicans acknowledge the need to keep costs down, but say the program is riddled with fraud and waste.

Republican Representative Jason Smith of Missouri, who had opposed the bill, said it would continue subsidies for the wealthy since there is no income cap, a concern some Democrats have said they would consider as part of a broader healthcare reform.

Allowing the subsidies to expire, Smith said, simply reverts the program to its original status before it was beefed up during the pandemic.

And that, Smith said, “means 93% of enrollees will still retain very generous subsidies.”