As the clock ticks down to the end of 2025, House Republicans are grappling with a health care conundrum that could send insurance costs soaring nationwide. With Obamacare subsidies set to expire in less than three weeks, the GOP's last session week of the year is mired in strategic chaos, potentially impacting their prospects in the upcoming midterm elections.

The leadership has scheduled a Wednesday vote on a set of conservative health policies introduced last Friday. However, the package notably omits an extension for the expiring Affordable Care Act (ACA) tax credits, an exclusion that could leave millions facing higher health care costs. In a nod to the anxieties within their ranks, GOP leaders will allow a vote on an amendment to extend the subsidies, though it is widely expected to fail.

House Budget Chair Jodey Arrington (R-Texas) remarked, “I expect people are going to have an opportunity to vote their conscience and then go defend their votes back home like we always do.”

Amidst this backdrop, moderate Republicans, particularly those from vulnerable districts, are scrambling to forge a last-minute deal to prevent a health care pricing shock. They propose a two-year subsidy extension with new income restrictions, a plan inspired by bipartisan efforts from Reps. Brian Fitzpatrick (R-Pa.) and Jared Golden (D-Maine).

Meanwhile, Democratic leaders are poised to react based on the final form of the amendment, with many criticizing the Fitzpatrick-Golden proposal as insufficient. The situation presents a strategic opportunity for Democrats to either support the amendment to challenge the GOP's stance or let it fail and highlight Republican disunity.

Adding to the tension, staunch conservatives oppose any vote on ACA subsidies, pressing for more restrictive measures and policy concessions in return for their support. This faction's resistance underscores the GOP's broader struggle to unify around a coherent health care strategy as the midterms loom.

The internal GOP conflict extends beyond health care. On Thursday, the House is set to vote on legislation aimed at speeding up energy project permitting, a move also facing conservative opposition.

Senate Majority Leader John Thune (R-S.D.) is concurrently pushing to wrap up significant legislative business, including the National Defense Authorization Act and a series of confirmations, before the holiday recess.

As House Republicans navigate these turbulent waters, Rep. Dan Meuser (R-Pa.) summed up the sentiment of many: “A lot of people are receiving this health care — they don’t need the rug pulled out from under them... I don’t see how we just leave things in limbo.”

With the end of the year fast approaching, all eyes are on how the GOP will handle the potential health care crisis and its implications for their electoral future.