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 (ACA) tax subsidies but would make other changes leaders say will improve access to care.
Time is running out for Congress. Once the enhanced subsidies for people who buy ACA marketplace plans expire at the end of the year, millions could see premiums skyrocket. Democrats have pushed to extend those enhanced tax credits to prevent premiums from doubling or more. The enhanced subsidies began in 2021 to make marketplace plans more affordable.
House members have four days left in the session before their holiday recess begins Dec. 19; the Senate recess begins Dec. 20. Friday’s House GOP proposal includes measures to let small businesses join together to buy insurance for employees and new requirements for pharmacy benefit managers aimed at lowering drug costs. Starting in 2027, federal cost‑sharing reduction payments would aim to lower premiums for some low‑income Americans, but health plans that provide abortion coverage would be excluded. House Speaker Mike Johnson said a vote on the package is expected next week.
Democratic House Minority Leader Hakeem Jeffries criticized the proposal, saying it fails to extend ACA tax credits and “is a deeply unserious proposal.” A Democratic-led Senate bill to extend subsidies for three years, joined by a handful of Republicans, failed to pass this week, as did a separate Senate Republican plan; neither gathered enough support to clear the chamber’s de facto 60‑vote threshold.
President Trump has advocated giving people money to pay for health care costs rather than extending ACA tax credits, saying funds should go to people and not insurance companies. The Senate GOP proposal had included up to $1,500 for health savings accounts for people earning less than 700% of the federal poverty level, paired with high‑deductible plans; the House Republican proposal does not include that language. Democrats opposed the Senate GOP bill, arguing it wouldn’t help Americans pay premiums and objecting to restrictions on abortion and gender‑affirming care.
Some Republicans have warned that ending ACA subsidies could cost the party in the midterms, and a number of House Republicans are seeking ways to extend the subsidies, including efforts to force a floor vote over party leaders’ objections.