House Republicans Introduce Healthcare Proposal
House Republicans have presented new healthcare legislation following the Senate's inability to advance its own bills regarding healthcare costs. The proposal, released late Friday, does not include an extension of enhanced Affordable Care Act (ACA) tax subsidies, instead offering alternative changes that party leaders assert will improve Americans' access to health care.
Context: Expiring Subsidies
Congressional action is pending as enhanced tax credits for individuals purchasing health plans through the ACA are scheduled to expire at the end of the year. The cessation of these subsidies could result in increased premiums for millions of Americans. Democrats have advocated for extending these enhanced tax credits to mitigate significant premium increases. These enhanced subsidies were introduced in 2021 to make ACA marketplace plans more affordable. The ACA marketplace originated from health reform legislation signed into law in 2010.
Legislative Timeline
The House of Representatives has four legislative days remaining before its holiday recess commences on December 19. The Senate's recess is set to begin on December 20.
Details of the House Republican Proposal
The Republican proposal encompasses several measures:
- It would allow small businesses to jointly purchase insurance plans for their employees.
- It introduces new requirements for pharmacy benefit managers (PBMs) with the stated objective of lowering drug costs.
- Starting in 2027, federal cost-sharing reduction payments are intended to decrease premiums for some low-income Americans. Health plans that include abortion coverage would be excluded from these payments.
A vote on this legislative package is anticipated next week, according to House Speaker Mike Johnson. Speaker Johnson stated in a release that the proposal addresses "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."
Democratic Opposition
House Minority Leader Hakeem Jeffries criticized the proposal on Saturday, stating on X that it "fails to extend the ACA tax credits that expire this month" and characterized it as "a deeply unserious proposal."
Previous Senate Efforts
Earlier in the week, a Democratic-led proposal in the Senate to extend ACA plan subsidies for three years did not pass, despite gaining some Republican support. A separate plan supported by Senate Republicans also failed to secure sufficient votes, as both bills did not meet the chamber's de facto 60-vote threshold.
Trump's View on Healthcare Funding
Former President Trump has expressed a preference for direct financial assistance to individuals for healthcare costs rather than tax credits for ACA plans. During a White House event on Friday, Trump stated, "I want to see the billions of dollars go to people, not to the insurance companies," and expressed a desire for individuals to "buy themselves great health care."
Differences with Senate Republican Plan
The House Republican proposal does not incorporate language from the earlier Senate GOP plan, which suggested up to $1,500 in health savings accounts (HSAs) for Americans earning less than 700% of the federal poverty level. These HSAs, which could not be utilized for premiums, were to be paired with high-deductible insurance plans. Such plans have an average deductible of approximately $7,000, according to an analysis by KFF. Democrats had opposed the Senate GOP bill, citing concerns regarding its limited assistance for premium costs and objecting to included restrictions on abortion and gender-affirming care.
Internal Republican Dynamics
Some Republicans have indicated concern that the termination of ACA subsidies could adversely affect their party in future elections, referencing constituent feedback. Reports suggest efforts are underway by some House Republicans to identify methods to extend subsidies, including attempting to compel a floor vote despite objections from party leadership.