A bipartisan coalition in the House voted Wednesday to advance legislation that would revive enhanced pandemic-era health insurance subsidies that expired last month, defying opposition from Speaker Mike Johnson and House Republican leadership.

The measure passed a key procedural hurdle by a 221-205 vote, with final passage expected Thursday. The legislation aims to reinstate subsidies that had lowered health insurance costs for approximately 22 million Americans through the Affordable Care Act marketplace.

Four centrist Republican lawmakers joined with Democrats to force the vote through a rarely successful parliamentary maneuver known as a discharge petition. By the time of the procedural vote, nine Republicans had crossed party lines to support the measure.

“No matter the issue, if the House puts forward relatively strong, bipartisan support, it makes it easier for the senators to get there,” said Rep. Mike Lawler of New York, one of the Republicans who backed the Democratic proposal.

The four Republicans who signed the discharge petition—Brian Fitzpatrick, Robert Bresnahan and Ryan Mackenzie of Pennsylvania, and Lawler of New York—all represent competitive swing districts that will be crucial in determining House control after November’s elections.

These lawmakers argued that inaction was unacceptable as their constituents faced substantial premium increases following the subsidies’ expiration. The issue remained unresolved even after last year’s government shutdown negotiations failed to address it.

For Johnson and House Republican leadership, the procedural defeat represents a significant blow to their control of the chamber’s agenda. The Speaker had reportedly considered allowing vulnerable GOP members to vote on temporary extensions with additional restrictions, but ultimately sided with the conservative wing of his party, which has criticized the subsidies as propping up what they consider a failed program.

Even if the bill passes the House, its path forward remains uncertain. The Senate is not obligated to take up the House-passed measure, and a bipartisan group of senators is already working on an alternative approach.

Senate Majority Leader John Thune (R-SD) outlined several components that would be necessary for any Senate compromise: income limits to target assistance to those most in need, requirements that beneficiaries pay at least nominal amounts for coverage to prevent insurance companies from automatically enrolling people, and expansion of health savings accounts.

“Insurance companies can’t game the system and auto-enroll people,” Thune said, emphasizing the need for guardrails in any final legislation.

The House proposal would extend the enhanced subsidies for three years, while the Senate negotiators are reportedly considering a two-year extension with programmatic changes.

Democratic Leader Hakeem Jeffries, who spearheaded his party’s effort to advance the issue, particularly challenged Republicans in competitive districts to support the measure if they wanted to prevent steep premium increases for their constituents.

Before Wednesday’s vote, Jeffries urged colleagues to “address the health care crisis in this country and make sure that tens of millions of people have the ability to go see a doctor when they need one.”

Democrats are signaling that health care costs will be a central campaign issue as they attempt to regain majorities in both chambers of Congress this November. The expiration of these subsidies provides a concrete example of rising costs they can point to on the campaign trail.

Discharge petitions have historically been difficult to execute successfully, requiring 218 signatures to force floor action against leadership wishes. However, this Congress has seen multiple successful petition drives, including one that forced a vote on releasing Justice Department files related to Jeffrey Epstein.

The bipartisan support for this health insurance measure reflects both the political salience of health care costs and the precarious position of moderate Republicans in competitive districts who feel compelled to show independence from party leadership on kitchen-table economic issues affecting their constituents.