Yesterday, the U.S. House of Representatives passed a bill to extend COVID-era Affordable Care Act (ACA) premium tax credit subsidies, which expired at the end of 2025, through 2028 by a vote of 230-196.

The premium tax credit structure was introduced in the American Rescue Plan Act of 2021 and later extended through 2025 by a 2022 reconciliation act. It was initially implemented as a means of reducing out-of-pocket costs for the premiums enrolled members pay for health insurance purchased through the marketplaces established by the ACA.

Now the bill will move to the Senate for review and possible amendments before it reaches President Donald Trump’s desk. Though it faces partisan opposition along the way. Only 17 Republicans broke from the party to vote alongside Democrats in the House’s vote.

For the behavioral health sector, the legislation’s passage would broaden access to affordable insurance that covers mental and behavioral health care, including substance use disorder treatment, since these services are generally covered under ACA plans.

“Without these subsidies, premiums are increasing drastically and expected to lead to massive coverage losses that will cause disproportionate harm to people with chronic health issues, including substance use disorders (SUDs) and mental health conditions, who will no longer be able to afford the care they need,” a statement from the Legal Action Center reads.

This could be game-changing for some enrollees, since ACA month premiums for plans purchased through the ACA marketplace already doubled at the beginning of 2026.

It could prevent coverage loss, and as a result, help mental and behavioral health providers’ services remain viable. This is something many industry providers have feared for their patients since the July passage of the One Big Beautiful Bill Act, which projections estimated would, by 2034, increase the number of uninsured Americans by 11.8 million.

However, if the new legislation passes the Senate and is subsequently signed into law, the nonpartisan Congressional Budget Office estimates that it would increase the number of insured individuals by 100,00 in 2026, 3 million in 2027, 4 million in 2028 and 1.1 million in 2029. The bill’s passage could also raise the federal deficit by $80.58 billion between now and 2035, according to its projections.

“The estimated increase in the number of people with health insurance relative to the number under current law is smaller for 2026 than for 2027 or 2028,” Phillip Swagel, director of the CBO, wrote in the report. “That smaller number for 2026 reflects CBO’s expectation that people who are shopping for insurance would not see net premiums that incorporate the expanded credit structure before the close of the annual enrollment period for the 2026 plan year.”

The CBO also estimates that gross premiums for marketplace benchmark plans would be lower by 5.7% in 2027, decrease further by 9% in 2028 and lower by an additional 3.3% in 2029. This, Swagel writes, would be a result of “the expectation that, on average, the people who enroll in the marketplaces would be healthier than would be the case without the extension.”

Speaker of the House Mike Johnson (R-La.) has been vehemently opposed to the bill and the extension of ACA subsidies, calling them a “magnet for fraud.” In a Jan. 8 statement prior to the bill’s passage, Rep. Johnson cited a December report published by the Government Accountability Office (GAO), which found that the GAO’s attempts to sign up as fake individuals with falsified information and Social Security numbers were, in many cases, approved for $10,000 per month subsidies under the ACA.

However, GAO points out that “the results, while illustrative, cannot be generalized to the full enrollment population.”

“We urge the Senate to follow the House and pass this critical legislation immediately,” Teresa Miller, Legal Action Center’s national director of health initiatives, said in a statement. “Doing so promptly is vital, as is addressing the spikes in premiums already being felt by millions across the country. Ensuring continued, affordable coverage and access to care, including SUD and mental health services, is a life-or-death matter for many people struggling across the country.”

It remains to be seen what the Senate will do with the legislation, but House Democrats are not optimistic about the bill’s trajectory. Congressman Jimmy Gomez (D-Calif.) stated that “Donald Trump and Senate Republicans are standing in the way and may not even allow a vote.”