After the Senate failed this week to advance competing health care bills, House Republicans late Friday unveiled their own package that would not extend the enhanced Affordable Care Act (ACA) tax subsidies but includes other changes they say will improve access and lower costs.
The expanded ACA subsidies, enacted in 2021, are scheduled to expire at the end of the year, and lawmakers have warned that millions of people who buy coverage on the ACA marketplace could face large premium increases if Congress does not act. Democrats have pushed to extend those credits to prevent premiums from surging.
With the House due to recess Dec. 19 and the Senate Dec. 20, time is short for a congressional solution. The House GOP plan would let small businesses band together to buy insurance for employees and would impose new requirements on pharmacy benefit managers intended to curb drug prices. It also would create federal cost-sharing reduction payments beginning in 2027 to lower out-of-pocket costs for some low-income enrollees; plans that cover abortion would be barred from receiving those payments.
Speaker Mike Johnson said a vote on the package is expected next week and described the measures as targeting the “real drivers” of health care costs to expand affordability, access and choice. House Democratic Leader Hakeem Jeffries criticized the plan for failing to extend the expiring ACA tax credits and called it “deeply unserious.”
Earlier in the week, a Democratic-led Senate bill to extend the enhanced subsidies for three years failed to win the roughly 60 votes needed in the chamber, and a separate Senate Republican proposal also fell short. The GOP Senate plan would have deposited up to $1,500 into health savings accounts (HSAs) for people earning less than 700% of the federal poverty level; that money could not be used for premiums and would have been paired with high-deductible plans. The House GOP package does not include that HSA provision. Analyses show average deductibles for many high-deductible plans can be roughly $7,000.
Democrats opposed the Senate Republican proposal on the grounds it would not sufficiently address premium costs and included restrictions on abortion and gender-affirming care. Some Republicans have warned that allowing the enhanced ACA subsidies to lapse could be politically damaging for the party, and a number of House Republicans are exploring ways to extend the credits, including efforts to force a floor vote despite leadership objections.
Former President Trump has urged giving direct funds to people to pay health costs rather than extending ACA tax credits, saying he wants money to go “to people, not to the insurance companies.”