After Senate Failure, House GOP Rolls Out Its Own Health Care Proposal Amid ACA Subsidy Deadline
After the Senate failed this week to advance legislation aimed at curbing health care costs, House Republicans late Friday rolled out a new proposal that would not extend enhanced Affordable Care Act tax subsidies, instead offering a different set of changes they argue would improve access to care.
The clock is ticking for Congress. The enhanced subsidies for Americans who purchase coverage through the Affordable Care Act are set to expire at the end of the year, a move that could cause premiums for millions of people to surge sharply.
Democrats have pushed to extend the tax credits, warning that without action, premiums could double or rise even more for many families. The enhanced subsidies were first enacted in 2021 to make marketplace plans more affordable and to expand coverage.
The ACA marketplace was created under the 2010 health reform law signed by Barack Obama, legislation Republicans have long opposed. With only four legislative days remaining before the House breaks for its holiday recess on Dec. 19, and the Senate following on Dec. 20, time for a compromise is rapidly running out.
The House GOP proposal includes provisions allowing small businesses to band together to purchase insurance for employees and introduces new requirements for pharmacy benefit managers, steps Republicans say would help rein in prescription drug costs.
Beginning in 2027, the plan would also create federal cost-sharing reduction payments designed to lower premiums for some low-income Americans. However, health plans that include abortion coverage would be excluded from receiving those payments.
House Speaker Mike Johnson said a vote on the package is expected next week, framing the proposal as a serious attempt to address rising costs.
“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.
Democrats swiftly criticized the plan. House Minority Leader Hakeem Jeffries called it “toxic,” arguing that it fails to protect families from looming premium hikes by letting the ACA tax credits expire.
“It fails to extend the ACA tax credits that expire this month,” Jeffries wrote on X, calling the proposal “deeply unserious.”
Earlier this week, a Democratic-led Senate bill to extend the subsidies for three years fell short, despite backing from a handful of Republicans. A separate GOP-backed Senate plan also failed to clear the chamber’s effective 60-vote threshold.
President Donald Trump has weighed in on the debate, arguing that federal dollars should go directly to individuals rather than insurers. “I want to see the billions of dollars go to people, not to the insurance companies,” Trump said Friday at a White House event.
The Senate GOP proposal had included a provision allowing Americans earning less than 700% of the federal poverty level to receive up to $1,500 in health savings accounts, though that language is not included in the House bill. Under the Senate plan, those accounts would have been paired with high-deductible health plans, which carry average deductibles of about $7,000, according to KFF.
Democrats opposed the Senate Republican approach, arguing it did little to help with premium costs and objecting to provisions that would have restricted abortion and gender-affirming care.
Meanwhile, some Republicans have privately warned party leaders that allowing the ACA subsidies to lapse could prove politically costly in the midterm elections, citing growing concern from constituents. Several House Republicans are now exploring procedural options to force a vote to extend the subsidies, even over leadership objections.
