House Republicans Offer Narrow Health Plan as ACA Subsidies Loom

House Republican leaders released a compact health care package late on Friday as lawmakers raced against a year end deadline that will determine whether enhanced Affordable Care Act premium subsidies continue. Speaker Mike Johnson framed the proposal as an assault on rising costs and a restoration of market integrity, saying, “While Democrats demand that taxpayers write bigger checks to insurance companies to hide the cost of their failed law, 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.”

The package assembled a set of previously advanced Republican measures rather than extending the enhanced subsidies whose lapse is projected to produce sharp premium increases for more than 20 million Americans. Leaders described the approach as narrow and targeted, bundling long standing priorities dating back to the party's 2017 push to replace the ACA.

Key elements reported in the proposal included expanded association health plans that would enable multiple employers to band together to buy coverage, restoration of funding for cost sharing reduction payments intended to lower premiums and out of pocket costs for some enrollees, new transparency requirements for pharmacy benefit managers aimed at reducing prescription drug costs, and expansions of health savings accounts paired with certain high deductible ACA plans. Senate Republicans had offered a related framework on December 8 to fund federal health savings accounts for some enrollees, but House leadership reportedly dismissed that approach as insufficient.

Absent from the package was a clean, time limited extension of the enhanced premium subsidies that Democrats and some moderates have argued is necessary to prevent a market shock. House leaders said they would allow an amendment vote on a subsidy extension sought by Democrats and moderate Republicans, but that procedural concession is unlikely to resolve deep policy differences ahead of the impending deadline. A bipartisan alternative offered earlier this month by Representative Jen Kiggans and Representative Josh Gottheimer proposed a one year subsidy extension with income limits and remains a point of negotiation.

The stakes are overtly political and plainly public health related. Enhanced subsidies have been credited with keeping coverage affordable for millions, and their expiration would raise premiums and out of pocket costs for people who lean heavily on ACA marketplaces. Community health advocates warn that the brunt will fall on lower income households and communities of color that gained coverage through expanded affordability measures, and that any lapse will worsen disparities in access and financial security.

With a House vote on the GOP package reportedly slated for the week following December 12, the coming days will test whether last minute legislative seam work can bridge partisan divides before insurers set 2026 premiums. The choice confronting Congress is stark: a narrow set of reforms that may leave millions facing higher costs, or a bipartisan path to preserve subsidy protections while negotiating long term fixes for market stability and equity.