Republican members of the House and Senate are splitting from their party to back efforts to prolong Affordable Care Act (ACA) health coverage subsidies, worried about the impending expiration of the tax credits and the resulting premium increases.

GOP leaders aim to maintain party unity behind a health care plan that would let the subsidies, used by over 20 million Americans, lapse at year’s end, proposing to counter expected premium rises by broadening health savings accounts. However, with the deadline approaching and anxiety about the party’s electoral prospects growing after a series of Democratic wins nationwide, more Republicans are opposing their leadership and aligning with Democrats to force a vote on extending the subsidies.

On Thursday, four Republican Senators—Susan Collins of Maine, Lisa Murkowski and Dan Sullivan of Alaska, and Josh Hawley of Montana—voted to advance a three-year subsidy extension. The bill, brought forward by Senate Minority Leader Chuck Schumer, did not proceed, however, as it lacked the required 60 votes.

“Families in Maine and nationwide are grappling with expensive health insurance, and I aim to stop an unaffordable surge in premiums for numerous Americans dependent on these COVID-era subsidies,” stated Collins, who faces re-election next year, in a release after her vote.

Collins and the three other GOP senators who sided with Democrats also voted to advance a separate proposal from Republican Senators Bill Cassidy of Louisiana and Mike Crapo of Idaho, which would have created health savings accounts for people buying insurance on the ACA marketplace. That legislation also failed to reach the 60-vote threshold.

In the House, where GOP leaders were finalizing their health care proposal for release on Friday, a faction of Republican legislators has endorsed maneuvers to compel votes on subsidy extension bills.

Twelve House Republicans have endorsed a discharge petition filed Wednesday by Pennsylvania Rep. Brian Fitzpatrick, designed to bring a two-year tax credit extension bill to the floor. “Congress must not stand by as American families confront an avoidable crisis. Our duty is to safeguard those we represent, and that obligation requires swift action,” Fitzpatrick said in a statement. “This legislation provides the critical assistance families require immediately, while allowing Congress time to continue enhancing our healthcare system for the future. Responsible leadership involves securing 80 percent of what families need today, instead of gambling on getting 100 percent of nothing tomorrow.”

By Friday afternoon, the Republican signers included Representatives Michael Lawler and Nick LaLota of New York, Robert P. Bresnahan and Ryan Mackenzie of Pennsylvania, Kevin Kiley and David Valadao of California, Don Bacon of Nebraska, Jefferson Van Drew of New Jersey, Jennifer Kiggans of Virginia, Marjorie Taylor Greene of Georgia, and Maria Elvira Salazar of Florida.

A comparable petition introduced by Democratic New Jersey Rep. Josh Gottheimer and Republican Jennifer Kiggans, which would force a vote on a bill with a one-year tax credit extension, has been signed by the same GOP lawmakers, excluding Salazar.

For months, Democrats have advocated for an extension of the ACA subsidies, highlighting the issue during the historic government shutdown. They eventually agreed to vote with Republicans to end the shutdown after Senate Majority Leader John Thune pledged a mid-December vote on a subsidy extension bill of their choice.

Yet, with the expiry date now under three weeks away, Democrats have not obtained a floor vote on an extension, and Congress lacks a clear path to address the forecasted jump in health insurance expenses.

The bills central to this week’s House discharge petitions face steep odds and remain well below the support needed to use the procedural tool successfully. Discharge petitions need the endorsement of a simple majority, or 218 members; besides the Republican dissenters, twelve Democrats have signed Fitzpatrick’s petition to date, and 28 have signed the one from Gottheimer and Kiggans. Any legislation approved by the House would also need to clear the Senate.

Several Republicans have cautioned that not averting a health care cost surge could damage the party in next year’s elections. Although the GOP achieved major gains in 2024, winning control of Congress and the White House, Republicans approach the 2026 elections with a narrow and diminishing House majority, as more incumbents choose not to run again, and the President’s party usually loses seats in midterms. Recent sweeping Democratic wins in gubernatorial races in states like Virginia, local elections in Georgia, and even in Miami, which this week elected its first Democratic mayor in three decades, have intensified GOP worries about November.

Last year, voters ranked the economy as a top concern. Affordability worries have persisted this year, including among constituencies that supported Trump’s return to office: A Politico poll published earlier this month revealed that almost half of all Americans, including 37% of 2024 Trump voters, believe the current cost of living is the worst they have ever experienced.

These cautionary signals loom over the current health care negotiations. “If we fumble this health care ball, nothing else is going to matter,” Florida Rep. John Rutherford told Politico. “If we don’t win the majority in the midterms, then none of this matters. We can’t do anything good then. I think everybody understands that.”