The Senate achieved nothing on the issue of health care this week. It is now the Chamber’s turn to show what it is capable of.
President Mike Johnson unveiled a Republican alternative late Friday, a last-minute sprint as his party refuses to extend enhanced tax subsidies for those who buy insurance policies through the Affordable Care Act, also called Obamacare, that expire at the end of the year. These subsidies help reduce the cost of coverage.
Johnson, R-La., huddled behind closed doors in the morning — as he did a few days earlier this week — to work on assembling the package for consideration as the House focuses the final days of its 2025 proceedings on health care.
“House Republicans are addressing the true cost drivers of health care to provide affordable care,” Johnson said in a statement announcing the package. He said it would be voted on next week.
However, later Friday, House Democratic Leader Hakeem Jeffries said, “House Republicans have introduced toxic legislation that is completely unserious, hurts hard-working American taxpayers, and is not designed to garner bipartisan support. If the bill reaches the House, I will strongly oppose it.”
Time is running out for Congress to act. Democrats staged the longest federal government shutdown ever this fall in a failed attempt to force Republicans to the health care negotiating table. But after promising votes, the Senate this week failed to advance both the Republican health care plan and Democrats’ proposed bill to extend the tax credits for three years.
Today, with days to go, Congress is on the verge of concluding its work with no consensual solution in sight.
What the Republicans are proposing
House Republicans have proposed a more than 100-page package that focuses on long-sought GOP proposals to improve access to employer-sponsored health insurance plans and crack down on so-called pharmacy benefit managers.
Republicans propose expanding access to so-called association health plans, which would allow more small businesses and self-employed people to band together and purchase health coverage.
Supporters say such plans increase the leverage companies have to negotiate a lower rate. But critics say the plans offer more limited coverage than required by the Affordable Care Act.
The Republican proposal would also require more data from pharmacy benefit managers, or PBMs, to help control drug costs. Critics say PBMs have improved their bottom lines and made it harder for independent pharmacists to survive.
Additionally, the Republican Party’s plan mentions cost-sharing reductions for some low-income people who rely on Obamacare, but these won’t take effect until January 2027.
The new package proposed by House Republicans does not include extending an enhanced tax credit for the millions of Americans who receive insurance coverage through the Affordable Care Act. Implemented during the COVID-19 crisis, this enhanced subsidy expires on December 31, leaving most families in the program facing more than double their current premiums, and in some cases, much more.
What Trump wants
President Donald Trump said he believed Republicans would come up with a better plan than Obamacare — something he has been promising for years — but offered few details beyond his idea of providing Americans with benefits to help them buy insurance.
“I want to see the billions of dollars go to the people, not the insurance companies,” Trump said Friday evening at a White House event. “And I want to see people go out and get good health care.” »
The president did not comment directly on the House’s new plan. He has repeatedly touted his idea of sending money directly to Americans to help offset the costs of health care policies, rather than extending tax credits to those who purchase policies through Obamacare. It’s unclear exactly how much money Trump is considering. The failed Senate GOP proposal would have provided payments into new health savings accounts of $1,000 a year for adult enrollees, or $1,500 for those 50 to 64.
It appeared there were no such health savings accounts in the new House GOP plan.
Political pressure increases for many
Going Johnson’s way has left vulnerable House Republicans, representing key battleground districts, in a tough spot.
Frustrated by the delays, a group of more centrist Republican lawmakers are aligning with Democrats to promote their own proposals to keep the tax credits in place, for now, so Americans don’t face rising health care costs.
They are following several paths to pass a temporary extension of the ACA subsidy, co-sponsoring a handful of bills. They also sign so-called discharge petitions that could force a floor vote if a majority of the House signs.
Such petitions are designed to circumvent majority control and are rarely successful, but this year proved to be an exception. Lawmakers, for example, were able to use a discharge petition to force a vote on the release of Jeffrey Epstein records held by the Justice Department.
One petition, filed by Rep. Brian Fitzpatrick, R-Pa., had the signatures of 12 Republicans and 12 Democrats as of Friday afternoon. This would force a vote on a bill that includes a two-year grant extension and contains provisions intended to combat fraud in the ACA marketplace. There are also restrictions for PBMs, among others.
Another petition from Rep. Josh Gottheimer, D-N.J., has 39 signatures and is largely bipartisan. This is a simpler proposal that would force a vote on a one-year extension of the ACA’s enhanced subsidy and include new income caps limiting who qualifies for the enhanced credit.
Both discharge petitions have enough Republican support that they would likely succeed if Jeffries encouraged his caucus to join. For now, he doesn’t raise his hand.
“We are actively reviewing both of these discharge petitions and will have more to say about them early next week,” Jeffries said.
Meanwhile, Jeffries is pushing for Democrats’ own discharge petition, which has 214 signatures and would provide a net extension of the grant by three years. No Republicans signed that one.
And as Republicans made clear in the Senate this week, a three-year extension without changes to the program has no chance of passing their chamber.
