House Republican leaders are moving forward with a comprehensive health-care bill that deliberately omits any provision to extend the pandemic-era tax credits that many Americans rely on. The bill arrives just months before those subsidies expire at the end of the year, a timing that critics say will push a wave of higher premiums into the next decade. Speaker Mike Johnson has been negotiating behind closed doors with a conservative faction that views the subsidies as a support for a failing ACA marketplace, and the result is a package that focuses on other reforms instead.
Johnson said on Tuesday at the Capitol that the leadership had explored a “pressure release valve” for the subsidies, but ultimately failed to secure an agreement. “We looked for a way to try to allow for that pressure release valve,” Johnson told reporters, adding, “In the end, it was not – an agreement wasn’t made.” The private talks were aimed at giving more GOP lawmakers a chance to vote on an amendment that would temporarily extend the subsidies for ACA coverage, but the conservative wing of the conference prevailed.
In the Senate, a bipartisan group is still working on a compromise to extend the subsidies, a matter that helped trigger this year’s government shutdown. Senators have made it clear that any legislation would likely wait until January, after the holiday break. The Senate’s stalled talks underscore the difficulty of reconciling the two chambers on the subsidies issue.
House Republicans plan to move forward with a 100-plus-page health-care package that prioritizes expanding coverage options for small businesses and the self-employed. A test vote is slated for Wednesday, and the proposal includes measures to clamp down on pharmacy benefit managers (PBMs) and broaden access to association health plans, which allow small employers and independent workers to band together and purchase coverage. The package also seeks to broaden coverage for small businesses and self-employed individuals by expanding association health plans, which allow groups of small employers to band together and purchase insurance, potentially lowering premiums.
An analysis by the Congressional Budget Office and the Joint Committee on Taxation projects that the package could reduce the number of insured Americans by an average of 100,000 each year over the 2027-2035 window, while trimming the federal deficit by $35.6 billion.
Rep. Mike Lawler, R-N.Y., slammed the leadership’s decision not to allow a vote on a temporary subsidy extension, calling it “political malpractice.” Lawler, who represents a competitive district, noted that most ACA-covered Americans live in states that former President Donald Trump won, and described the proposed extension as “conservative reforms.” He also criticized Democratic leader Hakeem Jeffries for failing to push Democrats toward bipartisan extension efforts, saying, “You have two leaders who are not serious about solving this problem.”
Johnson defended the GOP bill, emphasizing its long-term priorities. He said, “We have a long list of things that we know will reduce premiums, increase access and quality of care.” He added that Democrats have “zero ideas, zero concepts and zero legislative plans” on any alternative, except for subsidizing the broken system.
Democrats warned that even if the bill passes the House, it will not advance in the Senate, where a 60-vote threshold and bipartisan support are required. Rep. Suzan DelBene, chair of the House Democratic campaign arm, said, “Millions will be priced out of their coverage, and those who can still afford it will get less while paying more.” She added, “Republicans are ignoring the pain, the pain we’re seeing across the country for everyday Americans. And make no mistake, it is going to cost them the majority.” DelBene warned that the bill would leave many Americans without affordable coverage, noting that the Senate’s 60-vote threshold would likely block the proposal.
During President Trump’s first term, the administration sought to expand association health plans that are not required to offer the full menu of benefits mandated by the Affordable Care Act. These plans promise lower premiums for small businesses and self-employed people but typically cover fewer benefits. A 2018 federal judge struck down the effort, calling the plans an “end-run” around consumer protections. The House proposal would also restore federal funding for cost-sharing reductions, a benefit that insurers provide to low-income ACA enrollees on silver-level plans to lower deductibles and copays. The Treasury stopped those payments in 2017, causing insurers to raise silver premiums; restoring the funding would likely lower silver premiums but could raise net premiums on bronze and gold plans.
The bill would require pharmacy benefit managers to disclose specific operational data to group health plans, a move intended to increase transparency and curb prescription drug costs.
Almost two dozen Republicans and Democrats met late Monday to discuss a last-minute fix on ACA tax credits after the Senate rejected two partisan health-care bills. The meeting produced proposals for a possible two-year extension of the subsidies, with reforms that would narrow eligibility. The group also considered adding a GOP-style health savings account to help people purchase insurance. Senator Susan Collins, who led the bipartisan discussion, said the group would like to announce a proposal this week, though abortion-funding language remained a sticking point. Senate Majority Leader John Thune noted a “potential pathway” to an agreement in January but said the week’s work would not yield a bill. The debate over abortion funding reflects deeper ideological divides, with some senators demanding stricter language while others push for broader coverage.
The House bill, while promising lower premiums for certain groups, faces strong opposition from both sides of the aisle and a Senate that has yet to reach a consensus on subsidies. The debate highlights the challenge of balancing coverage expansion with affordability, and the coming weeks will see lawmakers weigh the trade-offs of a policy that could reshape the health-care landscape. As the House moves toward a vote, lawmakers on both sides face scrutiny from constituents and advocacy groups. The GOP’s emphasis on lower premiums for small businesses contrasts with Democratic concerns about coverage gaps and rising costs. Meanwhile, the Senate’s inability to agree on subsidies underscores the political impasse that could delay any comprehensive solution for millions of Americans. The coming weeks will determine whether the House bill becomes law or whether the Senate will push for a different approach to keep subsidies alive.
