WASHINGTON (AP) — This week, the Senate failed to make progress on the critical issue of health care. Now, the spotlight turns to the House of Representatives, where Speaker Mike Johnson has introduced a Republican alternative. This initiative was unveiled late Friday, marking a last-minute effort by the GOP as they refuse to extend the enhanced tax subsidies for individuals purchasing policies through the Affordable Care Act (ACA), commonly known as Obamacare. These subsidies, which significantly lower the cost of coverage, are set to expire at the end of this year.
On Friday morning, Johnson, a Republican from Louisiana, convened a closed-door meeting to finalize the details of the proposed health care package. The House is now in the final days of its 2025 legislative agenda, concentrating on health care issues. "House Republicans are tackling the real drivers of health care costs to provide affordable care," Johnson stated while announcing the package, which he indicated would be up for a vote next week.
However, House Democratic Leader Hakeem Jeffries responded sharply, labeling the Republicans’ legislation as "toxic" and "completely unserious." He criticized the proposal for harming hardworking American taxpayers and failing to seek bipartisan support. Jeffries made it clear that he would strongly oppose the bill if it makes it to the House floor.
As the clock ticks down, time is running out for Congress to find a solution. This fall, Democrats orchestrated the longest federal government shutdown in history in a failed attempt to pressure Republicans into negotiations over health care. Despite promises for votes, the Senate was unable to advance both a Republican health care plan and a Democratic proposal to extend tax credits for another three years this week. With only days remaining, Congress is nearing the end of its legislative session without a unified solution.
The House Republicans have put forth a comprehensive package, exceeding 100 pages, that emphasizes long-desired GOP initiatives. The plan aims to enhance access to employer-sponsored health insurance and regulate pharmacy benefit managers (PBMs). One key aspect of the proposal is the expansion of association health plans, which would enable small businesses and self-employed individuals to collaborate and purchase health coverage collectively. Proponents argue that these plans would enhance the negotiating power of businesses, potentially leading to lower rates. However, critics warn that such plans may offer less comprehensive coverage than what is mandated under the Affordable Care Act.
Moreover, the Republicans’ proposal includes provisions to increase transparency from PBMs, aiming to control rising drug costs. Critics have accused PBMs of prioritizing profits at the expense of independent pharmacists. While the GOP plan suggests cost-sharing reductions for some lower-income individuals reliant on Obamacare, these measures would not take effect until January 2027.
Notably, the emerging Republican package does not include an extension for the enhanced tax credit benefiting millions of Americans who obtain insurance through the Affordable Care Act. Initially implemented during the COVID-19 pandemic, this enhanced subsidy is set to expire on December 31, which could lead to families facing more than double their current out-of-pocket premiums.
Former President Donald Trump has expressed confidence that Republicans will develop a superior plan compared to Obamacare, a promise he has made for several years. However, he has shared few specifics, aside from suggesting that Americans should receive stipends to assist in purchasing insurance. "I want to see the billions of dollars go to people, not to the insurance companies," Trump stated during a recent event at the White House. He reiterated his preference for direct financial support to individuals rather than extending tax credits for those using Obamacare.
The Senate GOP plan that failed to advance proposed annual payments to new health savings accounts, amounting to $1,000 for adult enrollees and $1,500 for those aged 50 to 64. However, the new House GOP plan does not appear to include such health savings accounts.
Speaker Johnson's approach has placed vulnerable House Republicans in battleground districts in a challenging position. Frustrated by the ongoing delays, a group of more centrist GOP lawmakers is joining forces with Democrats to advocate for proposals that would temporarily extend the tax credits. They are pursuing various avenues to pass a short-term ACA subsidy extension, co-sponsoring several bills and signing onto discharge petitions that could force a floor vote if a majority of the House supports them.
Discharge petitions allow lawmakers to bypass majority control and are often unsuccessful, but this year has seen exceptions. For example, a discharge petition was successfully used to compel a vote on the release of the Jeffrey Epstein files held by the Department of Justice. One petition, initiated by Rep. Brian Fitzpatrick, a Republican from Pennsylvania, had garnered support from 12 Republicans and 12 Democrats by Friday afternoon. This petition aims to force a vote on a bill that includes a two-year subsidy extension and measures to combat fraud in the ACA marketplace.
Another petition, led by Rep. Josh Gottheimer, a Democrat from New Jersey, has 39 signatures and takes a more straightforward approach. It calls for a vote on a one-year extension of enhanced ACA subsidies with income caps limiting eligibility for the enhanced credit. Both petitions have sufficient bipartisan support that they could succeed if Jeffries encouraged his caucus to participate. However, he has yet to reveal his strategy regarding these petitions.
In the meantime, Jeffries is advocating for a separate discharge petition from Democrats, which has accumulated 214 signatures and would facilitate a clean three-year extension of the subsidy program. Notably, no Republicans have signed onto this proposal, and the sentiment in the Senate suggests that a three-year extension without modifications is unlikely to gain traction.