After the Senate failed to advance bills to address health care costs this week, House Republicans released proposed legislation late Friday that would not extend enhanced Affordable Care Act tax subsidies but would make other changes party leaders insist will improve Americans' access to health care.
Time is running out for Congress to act. Once the subsidies for Americans who buy health care plans through the Affordable Care Act (ACA) expire at the end of the year, millions of Americans' premiums will skyrocket.
Democrats have been pushing to extend those enhanced tax credits to prevent premiums from doubling or more.
The enhanced subsidies began in 2021 to make ACA marketplace plans more affordable for more Americans. The marketplace came out of the health reform President Barack Obama signed into law in 2010 that Republicans have long criticized.
House members have just four days left in the session before their holiday recess begins on Dec. 19. The Senate's recess begins Dec. 20.
Friday's proposal from House Republicans includes measures that would allow small businesses to join together to buy insurance plans for their employees and put in place new requirements for pharmacy benefit managers in an effort to lower drug costs.
Starting in 2027, federal payments, known as cost-sharing reduction payments, would aim to lower premiums for some low-income Americans. Health plans that provide abortion coverage would be excluded.
A vote on the package is expected next week, House Speaker Mike Johnson said.
"House Republicans are tackling the real drivers of health care costs to provide affordable care, increase access and choice, and restore integrity to our nation's health care system for all Americans," Johnson said in a statement.
Democratic House Minority Leader Hakeem Jeffries blasted the proposal Saturday.
"Mike Johnson just released a toxic Republican Healthcare plan that hurts everyday Americans," Jeffries wrote on X. "It fails to extend the ACA tax credits that expire this month. And is a deeply unserious proposal."
A Democratic-led proposal in the Senate to extend the subsidies for ACA plans for three years was joined by a handful of Republicans but failed to pass this week, as did a separate plan backed by Senate Republicans. Both bills failed to attract enough support to clear the chamber's de facto 60-vote threshold.
President Trump has advocated for giving money to people to pay for health care costs instead of tax credits for ACA plans.
"I want to see the billions of dollars go to people, not to the insurance companies," Trump said late Friday during a White House event. "And I want to see the people go out and buy themselves great health care."
The Republicans' plan in the Senate included a proposal for people to get up to $1,500 in health savings accounts for Americans earning less than 700% of the federal poverty level, but the House Republican proposal does not include that language.
In the Senate GOP's proposal, the savings accounts, which cannot be used to pay for premiums, would have been paired with high-deductible insurance plans. Such health plans have an average deductible cost of around $7,000, according to an analysis from KFF, a health policy organization.
Democrats opposed the Senate GOP bill, arguing it would not help Americans pay for health care premiums. They also objected to language that would have put restrictions on abortion and gender-affirming care.
Meanwhile, some Republicans have warned that ending ACA subsidies could cost their party the midterm elections, citing worried communications from their constituents. A number of Republicans in the House are seeking ways to extend subsidies, including by working to force a vote on the House floor over the objections of party leaders.
Copyright 2025 NPR
