• 111-page package expands association health plans and targets pharmacy benefit managers
• Enhanced Affordable Care Act subsidies expire December 31 without congressional action
• Moderate Republicans revolt with discharge petitions forcing subsidy extension votes

WASHINGTON, DC (TDR) — House Republicans led by Speaker Mike Johnson unveiled Friday a narrow health care package addressing rising costs without extending enhanced Affordable Care Act subsidies set to expire at year’s end, setting up a contentious floor vote next week as the party remains deeply divided over the issue. The 111-page Lower Health Care Premiums for All Americans Act focuses on expanding association health plans and imposing transparency requirements on pharmacy benefit managers rather than addressing the subsidy cliff facing more than 20 million Americans.

The GOP proposal scheduled for House floor consideration sometime next week would expand availability of association health plans allowing employers to band together to purchase coverage, along with CHOICE arrangements providing additional insurance options. The measure also appropriates funding for cost-sharing reductions to reduce premiums in the individual marketplace, though those provisions would not take effect until January 2027.

Johnson Defends Approach

Johnson defended the package in a statement declaring House Republicans are tackling real drivers of health care costs to provide affordable care, increase access and choice, and restore integrity to the nation’s health care system. The Speaker emphasized the plan focuses on addressing root causes rather than writing bigger checks to insurance companies to hide what he characterized as costs of Democrats’ failed law.

“House Republicans are tackling the real drivers of health care costs to provide affordable care.”

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Notably absent from the measure is funding for health savings accounts despite earlier discussions about expanding those programs. The proposal also mandates new transparency requirements for pharmacy benefit managers accused across party lines of inflating prescription drug prices and squeezing independent pharmacists. Critics warn association health plans typically provide skimpier coverage with weaker consumer protections than ACA marketplace policies currently available.

Democratic Opposition Intensifies

House Democratic Leader Hakeem Jeffries characterized the Republican proposal as toxic legislation that fails to address the coming premium spike resulting from subsidy expiration. Jeffries stated House Republicans are not serious about ending the health care crisis they have unleashed, noting the eleventh-hour measure doesn’t extend tax credits that tens of millions of Americans rely on for affordable health coverage.

Republican Revolt Grows

Nearly a dozen House Republicans representing swing districts have publicly defied Johnson by signing onto discharge petitions attempting to force floor votes on subsidy extensions. Representative Brian Fitzpatrick filed a petition garnering 12 Republican and 12 Democratic signatures that would mandate a vote on two-year subsidy extension with fraud prevention provisions and pharmacy benefit manager restrictions. Another petition from Representative Josh Gottheimer has 39 bipartisan signatures supporting a one-year extension with new income caps limiting enhanced credit eligibility.

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Both discharge petitions could succeed if Jeffries encourages Democratic caucus participation, though he has not yet committed support. Representative Don Bacon warned that allowing subsidies to expire will be used like a sledgehammer against Republicans during next year’s midterm elections. GOP leaders are discussing staging an amendment vote on subsidy extension, though specifics remain under negotiation.

Can House Republicans navigate internal divisions to pass health care legislation before subsidies expire?

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