WASHINGTON (AP) — In a remarkable rebuke of Republican leadership, the House passed legislation Thursday, 230-196, that would extend expired health care subsidies for those who get coverage through the Affordable Care Act as renegade GOP lawmakers joined essentially all Democrats in voting for the measure.

Forcing the issue to a vote came about after a handful of Republicans signed on to a so-called “discharge petition” to unlock debate, bypassing objections from House Speaker Mike Johnson. The bill now goes to the Senate, where pressure is building for a similar bipartisan compromise.

Together, the rare political coalitions are rushing to resolve the standoff over the enhanced tax credits that were put in place during the COVID-19 crisis but expired late last year after no agreement was reached during the government shutdown.

“The affordability crisis is not a ‘hoax,’ it is very real — despite what Donald Trump has had to say,” said House Democratic Leader Hakeem Jeffries, invoking the president’s remarks.

“Democrats made clear before the government was shut down that we were in this affordability fight until we win this affordability fight,” he said. “Today we have an opportunity to take a meaningful step forward.”

Ahead of voting, the nonpartisan Congressional Budget Office estimated that the bill, which would provide a three-year extension of the subsidy, would increase the nation’s deficit by about $80.6 billion over the decade. At the same time, it would increase the number of people with health insurance by 100,000 this year, 3 million in 2027, 4 million in 2028 and 1.1 million in 2029, the CBO said.

Growing support for extending ACA subsidies

Johnson, R-La., worked for months to prevent this situation. His office argued Thursday that the federal health care funding from the COVID-19 era is ripe with fraud, pointing to an investigation in Minnesota, and urged a no vote.

On the floor, Republicans argued that the subsidies as structured have contributed to fraud and that the chamber should be focused on lowering health insurance costs for the broader population.

“Only 7% of the population relies on Obamacare marketplace plans. This chamber should be about helping 100% of Americans,” said Rep. Jason Smith, the Republican chairman of the House Ways and Means Committee.

While the momentum from the vote shows the growing support for the tax breaks that have helped some 22 million Americans have access to health insurance, the Senate would be under no requirement to take up the House bill.

Instead, a small group of senators from both parties has been working on an alternative plan that could find support in both chambers and become law. Senate Majority Leader John Thune, R-S.D., said that for any plan to find support in his chamber, it will need to have income limits to ensure that the financial aid is focused on those who most need the help. He and other Republicans also want to ensure that beneficiaries would have to at least pay a nominal amount for their coverage.

Finally, Thune said there would need to be some expansion of health savings accounts, which allow people to save money and withdraw it tax-free as long as the money is spent on qualified medical expenses.

Sen. Jeanne Shaheen, D-N.H., who is part of the negotiations on reforms and subsidies for the Affordable Care Act, said there is agreement on addressing fraud in health care.

“We recognize that we have millions of people in this country who are going to lose — are losing, have lost — their health insurance because they can’t afford the premiums,” Shaheen said. “And so we’re trying to see if we can’t get to some agreement that’s going to help, and the sooner we can do that, the better.”

Trump has pushed Republicans to send money directly to Americans for health savings accounts so they can bypass the federal government and handle insurance on their own. Democrats largely reject this idea as insufficient for covering the high costs of health care.

Republicans go around their leaders

The action by Republicans to force a vote has been an affront to Johnson and his leadership team, who essentially lost control of what comes to the House floor as the Republican lawmakers joined Democrats for the workaround.

After last year’s government shutdown failed to resolve the issue, Johnson had discussed allowing more politically vulnerable GOP lawmakers a chance to vote on another health care bill that would temporarily extend the subsidies while also adding changes.

But after days of discussions, Johnson and the GOP leadership sided with the more conservative wing, which has assailed the subsidies as propping up ACA, which they consider a failed government program. He offered a modest proposal of health care reforms that was approved, but has stalled.

It was then that rank-and-file lawmakers took matters into their own hands, as many of their constituents faced soaring health insurance premiums beginning this month.

Republican Reps. Brian Fitzpatrick, Robert Bresnahan and Ryan Mackenzie, all from Pennsylvania, and Mike Lawler of New York, signed the Democrats’ petition, pushing it to the magic number of 218 needed to force a House vote. All four represent key swing districts whose races will help determine which party takes charge of the House next year.

Trump encourages GOP to take on health care issue

What started as a long shot effort by Democrats to offer a discharge petition has become a political vindication of the Democrats’ government shutdown strategy as they fought to preserve the health care funds.

Democrats are making clear that the higher health insurance costs many Americans are facing will be a political centerpiece of their efforts to retake the majority in the House and Senate in the fall elections.

Trump, during a lengthy speech this week to House GOP lawmakers, encouraged his party to take control of the health care debate — an issue that has stymied Republicans since he tried, and failed, to repeal Obamacare during his first term.

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Associated Press writer Matt Brown contributed to this report.

Lisa Mascaro And Kevin Freking, The Associated Press