December 5, 2025
By Laura Beltrán Figueroa, PhD
Update – December 24: After much delay, four Republicans have signed on to the discharge petition filed by Minority Leader Hakeem Jeffries to extend the enhanced premium tax credits for three years. This means that the legislation will be voted on in the U.S. House in January. We expect it to pass the House although there may not be time or the votes to pass it in the Senate.
Three of the four Republicans representatives are from Pennsylvania: Congressmen Fitzpatrick, Mackenzie, and Bresnahan. As you know, we and our partners—and many of those reading this post—have been calling on them to protect access to health insurance since January 2025. It may turn out to be too little too late. But we are glad they have acted.
Original post: Much work has been done by the Pennsylvania Policy Center and other advocacy organizations across the state to emphasize the disastrous effects that the expiration of the Affordable Care Act premium tax credits will have for Pennsylvania families. Not only will allowing these enhanced credits to lapse cause premiums to spike, fueling the affordability crisis we are already facing in Pennsylvania and nationwide, but it will also leave hundreds of thousands of families across the state priced out of health insurance, putting further strain on hospital finances, leaving all of us with worse access to care, and risking hospital closures down the line.
Republicans chose this path and have had months to come up with what they claim would be a better solution. Instead, they shut down the federal government for weeks and kept the House at home for much of the fall, wasting critical time that could have been used to protect families from these premium hikes. Now, as the deadline approaches and millions of people face the threat of losing coverage or paying double or triple for the same insurance, Republican leaders are floating last-minute, half-measure proposals that fall far short of what is needed. There are now multiple Republican and bipartisan proposals:
- The Bipartisan Healthcare Optimization, Protection, and Extension (HOPE) Act, led by Representatives Thomas Suozzi (D-NY), Don Bacon (R-NE), Josh Gottheimer (D-NJ), and Jeff Hurd (R-CO), would extend the enhanced premium tax credits for two years but would limit eligibility by imposing a new income cap for families, phasing out assistance for many middle-income households and adding fraud-focused provisions that could create new barriers for eligible enrollees.1
- A slimmer and more short-term version of that model, the Gottheimer-Kiggans “Common Ground 2025” framework borrows similar income caps and guardrails. It guarantees only a single year of extension, and then proposes a second-year “menu” of options that could weaken zero-premium coverage and shift more costs onto low- and middle-income families.
- The Fix It Act, sponsored by Representatives Sam Liccardo (D-CA) and Kevin Kiley (R-CA), similarly offers a two-year extension while capping eligibility at around six times the federal poverty level and folding in additional anti-fraud measures—again narrowing access over time.2
- The Bipartisan Premium Tax Credit Extension Act, introduced by Representatives Jen Kiggans (R-VA) and Tom Suozzi (D-NY), provides only a one-year extension of the enhanced credits through 2026, deliberately treating this as a short-term bridge rather than the multi-year solution families and insurers need for stability.3
Closer to home, Representative Brian Fitzpatrick (R-PA) has also been talking about yet another approach, reportedly extending the enhanced credits for two years while adding a new upper-income cap and shifting resources away from higher-income households toward lower- and middle-income enrollees, a structure that is better than doing nothing but still falls short of the clean, universal extension Pennsylvania families truly need.4
Now the question remains whether Republican leaders and self-described moderates will treat this as a real crisis or as a political talking point. Clearly, these middle-of-the-road proposals, especially those that do not eliminate zero-cost plans for those with low incomes or cap benefits for middle-class families, are better than other ideas Republicans advanced, which would let the enhanced credits lapse and push people into Health Savings Account schemes or skimpier coverage. All this would effectively get rid of meaningful premium support altogether. But none of them are better than the clean, multi-year extension that has been consistently advanced by Senate Democrats and by House Democrats through the Jeffries discharge petition.
At this point, the test is simple. A bill to extend the enhanced premium tax credits could pass the House if it were allowed to come to the floor. Given Speaker Johnson’s opposition, the most realistic path is for so-called moderate Republicans to join Democrats on the discharge petition and force a vote on a clean, multi-year extension that protects zero-premium coverage and avoids new income cliffs. Any Republican member who claims to support affordable health care but refuses to take that step—or to ensure that another good plan comes to the floor—is not doing everything they can to protect their constituents from steep premium hikes and loss of coverage.
[1] Office of Representative Thomas Suozzi, “The Bipartisan Healthcare Optimization Protection Extension (HOPE) Act Summary,” In the News, November 20, 2025, U.S. House of Representatives, Accessed December 5, 2025, https://suozzi.house.gov/sites/evo-subsites/suozzi.house.gov/files/evo-media-document/bipartisan-healthcare-optimization-protection-extension-act-summary_0.pdf.
[2] Sam Liccardo and Kevin Kiley, “The Fix It Act,” Fact Sheet, November 2025, Accessed December 5, 2025, https://d12t4t5x3vyizu.cloudfront.net/kiley.house.gov/uploads/2025/11/Fix-it-Act-Fact-Sheet.pdf.
[3] United States Congress, House, Bipartisan Premium Tax Credit Extension Act. H.R. 5145, 119th Cong., 1st sess. Introduced September 4, 2025, Accessed December 5, 2025, https://www.congress.gov/bill/119th-congress/house-bill/5145.
[4] Dan Snyder, “Pennsylvania Congressman Prepares Bill to Extend ACA Subsidies as Major Price Hikes Loom,” CBS Philadelphia, updated December 4, 2025, accessed December 5, 2025, https://www.cbsnews.com/philadelphia/news/aca-subsidies-2026-health-insurance/.