Vulnerable Republican calls decision to send health insurance hike ‘political malpractice’
House Republican leaders are determined to advance a GOP health care bill that excludes efforts to address the surge in monthly premiums that millions of Americans will soon experience as pandemic-era tax credits for people who buy insurance through the Affordable Care Act expire at the end of the year.
Speaker Mike Johnson had raised the possibility of allowing the most politically vulnerable Republican lawmakers to vote on his amendment that would temporarily extend subsidies for ACA pandemic coverage. But after days of private discussions, leaders sided with the conference’s more conservative wing, which blamed subsidies for underpinning the ACA’s market failure.
“We’ve been looking for a way to try to enable that pressure relief valve,” Johnson said Tuesday at the Capitol. “In the end, that wasn’t the case – no deal was reached.”
The maneuvering surrounding the health care vote virtually guarantees that many Americans will see significantly higher insurance costs in 2026. In the Senate, a bipartisan group was still trying to find a compromise to extend the subsidies, which fueled the government shutdown this year. But senators made clear that any potential legislation would likely wait until January, after the recess.
Instead, House Republicans will continue their more than 100-page health care agenda that focuses on long-sought GOP proposals designed to expand insurance coverage options for small businesses and the self-employed. A test vote is expected on Wednesday.
The Republicans’ plan would crack down on middlemen called pharmacy benefit managers who work to manage drug costs and process claims for insurance plans. The bill would also expand access to so-called association health plans, allowing more small businesses and self-employed individuals to band together and purchase health coverage.
An analysis by the nonpartisan Congressional Budget Office and the Joint Committee on Taxation estimates that the plan would reduce the number of people with health insurance by an average of 100,000 per year over the 2027-2035 period, while reducing the federal deficit by $35.6 billion.
Failing to Address the “Political Malpractice” of Expiring Insurance Subsidies
Rep. Mike Lawler, R-N.Y., blasted leaders’ decision not to allow a vote to temporarily extend health insurance subsidies, saying it amounted to “political malpractice.”
Lawler, from a competitive district, noted that most people receiving health coverage through the Affordable Care Act live in states won by President Donald Trump and said the proposed changes for a temporary extension were “conservative reforms.” He also criticized Democratic leader Hakeem Jeffries for not pushing Democrats to support two bipartisan expansion efforts.
“You have two leaders who don’t really want to solve this problem,” Lawler said of Johnson and Jeffries.
Centrist Republicans nevertheless indicated that they would not try to prevent the Republican leadership’s measure from passing.
Johnson defended the House GOP’s bill, which includes priorities that Republicans have been working on for several years.
“We have a long list of measures that we know will reduce premiums, increase access and quality of care,” Johnson said. “Democrats have no ideas, no concepts, and no legislative plans for anything they are proposing other than simply subsidizing a broken system.”
Democrats said that even if the bill passed the House, it would not pass the Senate, where it would need 60 votes and bipartisan support to advance. They said it was not a serious effort to address rising costs.
“Millions will be left without coverage, and those who can still afford it will receive less while paying more,” said Rep. Suzan DelBene, chairwoman of the House Democratic campaign arm. “Republicans are ignoring the pain, the pain we’re seeing across the country for everyday Americans. And make no mistake, this is going to cost them the majority.”
GOP bill focuses on insurance options, cost sharing
During Trump’s first term, his administration sought to expand access to association health plans that are not required to offer the full range of benefits required under current law. The option offers lower premiums for small businesses and the self-employed, but the policies will likely cover fewer benefits. A federal judge who struck down the administration’s efforts in 2018 said the plans “clearly constituted a finality” around consumer protections required by the Affordable Care Act, also known as Obamacare.
The House Republican plan would also restore government funding for cost-sharing reductions, or CSRs, a type of financial assistance that insurers give to low-income ACA enrollees on silver-level plans that reduce their share of costs like deductibles and co-pays.
From 2014 to 2017, the federal government reimbursed insurance companies for CSRs – but in 2017, the Trump administration stopped making these payments. To make up for lost funds, insurance companies raised premiums for silver-level plans — a complicated decision that ended up increasing the financial assistance many enrollees receive to help pay their premiums.
As a result, health analysts say that while restoring CSR funding would likely reduce Silver-level premiums, it could also have the unwanted knock-on effect of increasing net premiums for many people on Bronze and Gold plans.
The pharmacy benefit manager provisions require intermediaries to disclose certain data about their operations to group health plans, in the hope that greater transparency would reduce prescription drug costs.
Senators revive talks on action in new year
Nearly two dozen Republicans and Democrats gathered Monday evening to discuss a last-minute fix on ACA tax credits after the Senate rejected two partisan health care bills last week. They emerged from the meeting discussing ways to break the impasse, including a possible two-year extension of the grants accompanied by reforms that would limit the number of beneficiaries. They also discussed adding a version of a GOP proposal to create new health savings accounts that would help people buy insurance.
Maine Sen. Susan Collins, a Republican who led the bipartisan meeting, said the group would like to announce a proposal this week. But there were still important unresolved questions, including whether to include stricter provisions on abortion funding. Disagreements over abortion were a major sticking point in previous negotiations that derailed a compromise.
Senate Majority Leader John Thune said there was a “potential path” to a deal in January, but acknowledged that “we’re not going to pass anything by the end of this week.”
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Staff writers Mary Clare Jalonick and Ali Swenson contributed to this report.
