As the Senate struggled to advance crucial bills aimed at addressing health care costs this week, House Republicans responded by releasing a proposed legislative package late Friday. This new proposal notably does not include an extension of the enhanced Affordable Care Act (ACA) tax subsidies, which are set to expire at the end of the year. Party leaders argue that their plan will enhance Americans' access to health care, but time is running out for Congress to take decisive action.
The expiration of enhanced subsidies could lead to significant increases in premiums for millions of Americans who rely on ACA marketplace plans. Since their introduction in 2021, these enhanced tax credits have played a critical role in making health care more affordable for many. The ACA, a cornerstone of health reform signed into law by President Barack Obama in 2010, has faced ongoing criticism from Republican lawmakers.
With just four days remaining in the House session before the holiday recess starts on December 19, and the Senate's recess commencing the following day, the urgency for legislative action is palpable. House Speaker Mike Johnson has indicated that a vote on the proposed package is expected next week.
The House Republican proposal includes several measures aimed at improving affordability and access to health care for Americans. One significant change would allow small businesses to band together to purchase insurance plans for their employees, potentially driving down costs through collective bargaining. Additionally, the legislation aims to implement new requirements for pharmacy benefit managers to help lower prescription drug costs.
Starting in 2027, the proposal outlines a plan for federal payments, known as cost-sharing reduction payments, to assist some low-income Americans in managing their premiums. However, it's important to note that health plans providing abortion coverage would be excluded from these benefits.
Democratic leaders have heavily criticized the Republican proposal. House Minority Leader Hakeem Jeffries condemned the plan as “toxic,” emphasizing that it fails to extend the crucial ACA tax credits that are set to expire soon. In a statement posted on X, Jeffries described the proposal as “deeply unserious” and detrimental to everyday Americans.
This week, a Democratic-led initiative in the Senate aimed at extending ACA subsidies for three years garnered some bipartisan support but ultimately failed to secure enough votes to pass. A separate proposal backed by Senate Republicans also did not meet the necessary threshold of 60 votes, highlighting the ongoing partisan divide over health care reforms.
Former President Donald Trump has suggested an alternative approach, advocating for direct financial assistance to individuals rather than extending tax credits for ACA plans. During a recent White House event, Trump stated, “I want to see the billions of dollars go to people, not to the insurance companies, and I want to see the people go out and buy themselves great health care.”
The Senate Republican plan included provisions for offering up to $1,500 in health savings accounts for individuals earning less than 700% of the federal poverty level. However, this language is absent from the House Republican proposal. The Senate's plan proposed that these savings accounts, which could not be used to pay for premiums, would be linked to high-deductible insurance plans, which typically have an average deductible of around $7,000, according to KFF, a health policy organization.
Democrats have voiced strong opposition to the Senate GOP bill, arguing that it does not provide adequate support for Americans struggling with health care premiums. They also raised concerns about provisions that would impose restrictions on abortion and gender-affirming care, further complicating the legislative landscape.