After the Senate failed this week to advance bills aimed at addressing health care costs, House Republicans released a proposed package late Friday that would not extend the enhanced Affordable Care Act (ACA) tax subsidies but includes other measures they say will improve access and lower costs.
The enhanced ACA subsidies, enacted in 2021, are set to expire at the end of the year, and lawmakers warn that millions of people who buy plans through the ACA marketplace could see premiums spike if Congress does not act. Democrats have pushed to extend those credits to prevent premiums from doubling or worse.
House members have only days left in the session before a holiday recess—Dec. 19 for the House and Dec. 20 for the Senate—raising the urgency of reaching an agreement.
The House GOP plan would allow small businesses to band together to buy insurance for employees and would impose new requirements on pharmacy benefit managers to try to lower drug prices. It would also create federal cost-sharing reduction payments beginning in 2027 aimed at lowering out-of-pocket costs for some low-income enrollees; plans that cover abortion would be excluded from receiving those payments.
Speaker Mike Johnson said a vote on the package is expected next week and framed the measures as addressing the “real drivers” of health care costs to expand affordability, access and choice. House Democratic Leader Hakeem Jeffries criticized the proposal, saying it “fails to extend the ACA tax credits that expire this month” and called it “deeply unserious.”
Earlier this week, a Democratic-led Senate bill to extend the enhanced subsidies for three years failed to secure the roughly 60 votes needed in the chamber, as did a separate Republican-backed Senate plan. The Senate GOP proposal would have offered up to $1,500 into health savings accounts for people earning less than 700% of the federal poverty level—money that could not be used to pay 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 around $7,000.
Democrats opposed the Senate Republican bill on the grounds it would not adequately help people with premium costs and included restrictions on abortion and gender-affirming care. Meanwhile, some Republicans have warned that allowing ACA subsidies to end could hurt the party politically in the midterms, and a number of House Republicans are exploring ways to extend the credits, including trying to force a floor vote despite leadership objections.
President Trump has advocated for 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.”