During a last-minute House debate on extending Affordable Care Act subsidies, Alabama’s delegation endorsed competing plans to lower insurance costs along party lines.
House Democrats, alongside a coalition of five Republican lawmakers, advanced a discharge petition on Wednesday to force a vote on a three-year extension of ACA subsidies.
The COVID-era subsidies are set to expire at the end of the year; however, the extension will not be voted on until 2026, as votes were cancelled on Friday, which marked the House’s last day in session this year.
The U.S. Senate failed to pass a similar bill to extend the subsidies last week, with both of Alabama’s senators opposing the measure.
Alabama’s House Republicans, meanwhile, have rallied behind a bill led by U.S. Representative Mariannette Miller-Meeks, R-Iowa, entitled the Lower Healthcare Premiums for All Americans Act, which does not provide an extension to ACA subsidies.
The bill instead includes funds to pay for “cost-sharing reductions,” reforms to the pharmacy benefit manager industry and an expansion of association healthcare plans—plans that allow small businesses and self-employed individuals to pool resources by joining an association to receive health insurance.
House Republicans have projected the bill will bring down average premium costs by 11 percent for ACA recipients.
The House Rules Committee blocked amendments proposed to the bill Tuesday night by Republican lawmakers who later signed onto the discharge petition, led by House Minority Leader Jakeem Jeffries, D-N.Y., including a provision that would have extended ACA subsidies for three years.
Healthcare nonprofit, the Kaiser Family Foundation, has projected that the lapse of ACA tax credits will cause insurance rates to more than double for subsidized plan recipients, who make up more than 90 percent of Alabama’s 477,000 ACA Healthcare Marketplace users.
In Alabama, KFF has reported that the end of the credits will increase average ACA premiums by 93 percent for subsidized recipients. 2026 premium costs for ACA plans as a whole have been increased by insurers by an average of 26 percent.
U.S. Representative Terri Sewell, D-Alabama, has condemned Republicans throughout the week for failing to advocate for ACA premium extension and called for an immediate vote on extending the subsidies.
Alongside releasing a written statement accusing Republicans of failing to address the premium affordability crisis, Sewell spoke in favor of premium extension on the House floor Wednesday and appeared among House Democrats at a Thursday rally on the Capitol steps, where Jeffries demanded an immediate vote on extension.
Sewell also decried the Lower Healthcare Premiums for All Americans Act’s association healthcare expansions as an inadequate alternative to subsidy extension.
“Millions of Americans will find themselves one diagnosis away from bankruptcy, but rather than addressing the crisis that they created, Republicans are pushing legislation that will make matters worse,” the representative said on the House floor. “Not only does this bill fail to extend the tax credit, but it promotes junk insurance plans that will rip off consumers and make healthcare even more unaffordable.”
“House Republicans are incapable of dealing with our nation’s affordability crisis. They should stop their political games and put the bipartisan Jeffries bills on the floor today,” Sewell added.
“We need to stay here—no holiday until we pass a bill that extends the tax credits for the Affordable Care Act,” Sewell said in a social media video Wednesday. “It’s mission-critical that we do this, and Democrats are ready to roll up their sleeves and get that job done.”
Alabama’s Republican representatives, meanwhile, have largely come out in favor of the Lower Healthcare Premiums for All Americans Act.
The act received the full support of Alabama’s House Republicans, with the exception of U.S. Representative Gary Palmer, R-Alabama, who did not cast a vote on the legislation Wednesday. Meanwhile, Sewell and U.S. Representative Shomari Figures, D-Alabama, cast votes against the bill.
Social media endorsements of the Republican backed legislation have been released by U.S. Representative Robert Aderholt, R-Alabama and U.S. Representative Dale Strong, R-Alabama.
“By passing the Lower Health Care Premiums for All Americans Act, we are making life more affordable for all Americans by: bringing down premiums, expanding coverage, and giving workers and families more choices,” Aderholt wrote on X on Wednesday.
“The Lower Health Care Premiums for All Americans Act advances common-sense provisions that put patients first, promote competition, and make health care more affordable for families across North Alabama by expanding coverage options for employers and individuals, lowering premium costs through cost-sharing reduction payments, and holding prescription drug market middlemen accountable,” Strong stated.
“For over 14 years, the Unaffordable Care Act has failed to put people and patients first,” the congressman wrote. “It has been proven that subsidies that line the pockets of insurance companies have done nothing to bring down health care costs for hardworking Americans.”
Executive Director of Alabama Arise Robyn Hyden, whose organization has advocated for ACA premium extension throughout 2025, told APR she was glad to see a bipartisan coalition force a vote on extension; however, she said she was disappointed the measure was unable to pass before the end of the year.
“I think it’s a really good sign that a bipartisan group of House members came together and said we absolutely have to fix this,” Hyden said. “It’s a sign that public pressure works, that even though the Republican Party line had been that it was a no-go, pressure from the members and from the states, actually, is going to make a vote happen.”
“If we don’t fix it, there could be another government shutdown, we will have huge rates of spiking medical debt and uninsured people,” she added. “So, yeah, I’m disappointed. I think we’ve been working all year, frankly, to mitigate the impacts of Congress’s attacks on the most vulnerable people in our country.”
Hyden cited that Alabama has one of the highest rates of ACA enrollment in the nation and expressed concern that an end to the subsidies would put strain on individuals and families unable to afford health insurance alongside the state’s healthcare system by causing an increase in uninsured individuals.
“We’re worried that potentially 191,000 Alabamians will just opt out entirely. And that will be a big step backwards,” Hyden said. “We’re very proud that we have increased our coverage rates because of these advanced premium tax credits. We have the highest rate of health insurance we’ve ever had in our state’s history. We’re about to lose all of that ground.”
She went on to say that while her organization has not developed a stance on the Lowering Healthcare Premiums for All Americans Act, she felt Republicans have so far been unable to provide a better solution to address the subsidies’ expiration than their extension.
“They have been hearing from a lot of Alabamians over the past several months about this. I think that they don’t have any better solutions. The solutions that have been proposed are so inadequate to address the scale of need,” Hyden said. “So, I would hope that hearing the calls for help, the calls for assistance from all over Alabama, voters from all different backgrounds, employers, that maybe they would have a change of heart, because, those are the people who are gonna be voting for them.”
