The House on Wednesday cleared a Republican health care package, 216-211, that does not extend the expiring Affordable Care Act (ACA) subsidies.

Four moderate Republicans who had earlier Wednesday bucked GOP leaders and signed a Democratic-backed discharge petition voted in favor of the health care package. Rep. Thomas Massie was the only Republican no vote.

The measure now goes to the Senate, where it’s unlikely to pass, meaning Congress is set to leave for the holiday recess as millions of Americans will see their health care premiums skyrocket.

Earlier Wednesday, House Speaker Mike Johnson denied he has “lost control of the House” after the GOP moderates revolted and joined Democrats’ effort to force a vote on a three-year extension of the ACA subsidies.

“We have the smallest majority in U.S. history, OK? These are not normal times. There are [processes] and procedures in the House that are less frequently used when there are larger majorities,” Johnson said. “When you have a razor-thin margin, as we do, then all the procedures in the book people think are on the table, and that’s the difference.”

Johnson’s assertion came after the four Republicans broke ranks and signed onto House Democratic Leader Hakeem Jeffries’ discharge petition, giving it the 218 signatures needed to force a vote, though that is not likely to occur until January 2026 at the earliest.

The decision by moderate Republican Reps. Brian Fitzpatrick, Mike Lawler, Rob Bresnahan and Ryan Mackenzie to join Democrats came after the Republican-controlled House Rules Committee on Tuesday night blocked amendments to extend the ACA subsidies from advancing.

Johnson has also resisted from allowing an up or down amendment vote on extending the expiring subsidies, which were Democrats’ focal point of the record 43-day government shutdown this fall.

Asked if he will allow a vote on the ACA extension in January, Johnson said, “Everybody stay tuned. We are having conversations.”

The speaker, who was spotted huddling with moderates on the floor during votes on Wednesday morning, said, “We just had some intense fellowship … We’re working through very complex issues, as we do here all the time, and it’s good. Everybody’s working towards ideas. We’re keeping the productive conversation going. That’s what happens.”

Moderate Republicans who signed onto the petition took aim at House leadership.

Lawler, of New York, said he doesn’t endorse the Democrats’ bill as written, but “when leadership blocks action entirely, Congress has a responsibility to act. My priority is ensuring Hudson Valley families aren’t caught in the gridlock,” Lawler wrote on X.

Pennsylvania’s Fitzpatrick again urged for an up or down vote on extending the ACA subsidies — calling on leadership to “let the House work its will.”

ABC News Capitol Hill Correspondent Jay O’Brien pressed Fitzpatrick on if signing the Democrats’ discharge petition will force GOP leadership to take a different approach. 

“I sure hope so,” he said. “But you have to let the people’s voice be heard on the House floor. You cannot not put bills on the floor because you’re afraid they’re going to pass. That’s not how this place should operate.”

Bresnahan, who also represents Pennsylvania, said leadership on both sides of the aisle failed to reach a bipartisan compromise on the ACA subsidies. 

“Doing nothing was not an option, and although this is not a bill I ever intended to support, it is the only option remaining,” he said in a statement. 

What happens next? 

The Republican-controlled House will hold vote on a clean three-year extension of the ACA subsidies; however, the vote is not expected to occur until January 2026 at the earliest given the rules for when a discharge petition can hit the floor.

The big question now is how the Senate will respond. The Senate already rejected a clean three-year extension of the subsidies in a pair of dueling health care votes last week, though several Republican senators crossed the aisle to join all Democrats in supporting it.