Late on Wednesday night, by a close vote of 216 to 211, the House has passed a GOP-backed health care bill that does not include an extension of expiring tax credits that help millions of Americans pay for health insurance under the Affordable Care Act. 

The GOP bill, known as the Lower Health Care Premiums for All Americans Act, includes policies that are widely popular among Republicans, including funds to pay for “cost-sharing reductions,” reforms to the pharmacy benefit manager industry, and an expansion of association health plans. But the exclusion of an extension of the Affordable Care Act tax credits sparked a revolt by a handful of moderate Republicans earlier in the day, none of whom ultimately voted against the bill. Rep. Thomas Massie was the only Republican to vote against the bill.

Four GOP members signed a Democratic discharge petition to force a vote on extending the subsidies for three years. Republican moderates have argued that letting the subsidies expire on Jan. 1 would lead to price hikes for millions of Americans and give Democrats a potent political issue heading into next year's midterm elections. The successful discharge petition was a direct rebuke of House Speaker Mike Johnson, who has refused to bring an extension up for a vote. He insisted earlier in the day that he has not lost control of the House. Johnson said it's "inevitable" that the Democrats' discharge petition on the three-year extension will be considered on the floor when lawmakers return in January.

The bill will now go to the Senate for a vote, where it has little chance of passing. Republican leaders say the party will continue to work on health care issues in the new year. Johnson on CNBC on Wednesday said he hopes to advance another reconciliation bill in the first quarter of the new year with more “revisions” to the health care system.