The U.S. House of Representatives passed a Republican-backed health care bill Wednesday evening, approving the legislation by a vote of 216–211 after floor debate.

The measure advanced with near-unanimous support from Republicans, with Rep. Thomas Massie of Kentucky’s 4th Congressional District casting the only Republican vote against the bill.

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The legislation, titled the Lower Health Care Premiums for All Americans Act, was sponsored by Rep. Mariannette Miller-Meeks of Iowa’s 1st Congressional District.

The bill moves forward without extending the Affordable Care Act’s COVID-era premium subsidies, which are set to expire on Dec. 31.

Those subsidies have been a major priority for Democrats and some Republicans, but were not included in the final legislation approved by the House.

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The vote came as Democrats have continued to press for an extension of the subsidies, arguing they are necessary to maintain affordability under the Affordable Care Act.

Republicans have countered that the subsidies mask deeper structural problems within the system and place long-term burdens on taxpayers.

Following passage of the bill, House Speaker Mike Johnson addressed reporters and Republican lawmakers, framing the legislation as a corrective measure after what he described as years of rising costs and unmet promises under the Affordable Care Act.

“The Democrats broke America’s health care system, when they gave us the ACA,” Johnson said.

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He added that the law should have been called the “Unaffordable Care Act.”

Johnson pointed to the original promises made by supporters of the Affordable Care Act, saying those commitments were not fulfilled.

“Fifteen years ago, they promised that premiums would come down that access would increase in quality of health care would increase,” he said.

“None of that happened because it’s a flawed system.”

He criticized Democrats for relying on subsidies to prop up the current framework.

“Their response right now is to subsidize and continue to shovel taxpayer dollars onto a broken system,” Johnson said.

“We say enough is enough!”

Johnson said Republicans believe the newly passed bill offers a broader solution to rising health care costs and system inefficiencies.

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“The Republican Party is the party that is bringing the ideas forward to fix this crisis and fix this problem for everyone,” he said, calling the situation “a serious problem.”

The speaker highlighted specific provisions in the GOP plan, including transparency requirements for pharmacy benefit managers, commonly known as PBMs.

Johnson contrasted those provisions with the Democratic push to extend COVID-era subsidies.

“We had the PBM, pharmacy benefit manager, transparency piece to it as well,” Johnson said.

“Now contrast that with the Democrats, COVID era subsidy that they wanted to extend that would only impact 7% of Americans.”

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Johnson also emphasized the fiscal impact of the competing proposals.

“The bill we just passed impacts 100% of Americans,” he said.

“Their version would impact 7% of Americans and it would cost taxpayers $350 billion.”

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Johnson described passage of the legislation as “a big step” and said House Republicans hope the Senate will move quickly to take up the measure.

He said the conference hopes “that this could [be signed into] law quickly because it will have the desired effect.”

He added, “We hope the Senate can get this done in short order.”

Rep. Miller-Meeks also celebrated the bill’s passage following the vote.

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Posting on X, she acknowledged the House victory and signaled the next phase of the legislative process, writing, “On to the Senate.”

The bill now awaits consideration in the Senate, where its future remains uncertain amid divided control and competing priorities over health care policy.

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