House GOP works to find health care plan as party remains split

WASHINGTON — The Senate failed to get anywhere on the health care issue this week. Now it's the House's turn to show what it can do.

Speaker Mike Johnson unveiled a Republican alternative late Friday, a last-minute sprint as his party refuses to extend the enhanced tax subsidies for those who buy policies through the Affordable Care Act, also called Obamacare, which are expiring at the end of the year. Those subsidies help lower the cost of coverage.

Johnson, R-La., huddled behind closed doors in the morning — as he did days earlier this week — working to assemble the package for consideration as the House focuses the final days of its 2025 work on health care.

“House Republicans are tackling the real drivers of health care costs to provide affordable care,” Johnson said in a statement announcing the package. He said it would be voted on next week.

Later Friday, though, House Democratic Leader Hakeem Jeffries said: “House Republicans have introduced toxic legislation that is completely unserious, hurts hardworking America taxpayers and is not designed to secure bipartisan support. If the bill reaches the House floor, I will strongly oppose it.”

Time is running out for Congress to act. Democrats engineered the longest federal government shutdown ever this fall in a failed effort to force Republicans to the negotiating table on health care. But after promising votes, the Senate failed this week to advance both a Republican health care plan and the Democratic-offered bill to extend the tax credits for three years.

Now, with just days to go, Congress is about to wrap up its work with no consensus solution in sight.

What Republicans are proposing

The House Republicans offered a 100-plus-page package that focuses on long-sought GOP proposals to enhance access to employer-sponsored health insurance plans and clamp down on so-called pharmacy benefit managers.

Republicans propose expanding access to what's referred to as association health plans, which would allow more small businesses and self-employed individuals to band together and purchase health coverage.

Proponents say such plans increase the leverage businesses have to negotiate a lower rate. But critics say the plans provide skimpier coverage than what is required under the Affordable Care Act.

The Republicans’ proposal would also require more data from pharmacy benefit managers, or PBMs, as a way to help control drug costs. Critics say PBMs have padded their bottom line and made it more difficult for independent pharmacists to survive.

Additionally, the GOP plan includes mention of cost-sharing reductions for some lower-income people who rely on Obamacare, but those do not take effect until January 2027.

The emerging package from the House Republicans does not include an extension of an enhanced tax credit for millions of Americans who get insurance coverage through the Affordable Care Act. Put in place during the COVID-19 crisis, that enhanced subsidy expires Dec. 31, leaving most families in the program facing more than double their current out-of-pocket premiums, and in some cases, much more.

What Trump wants

President Donald Trump has said he believes Republicans are going to figure out a better plan than Obamacare — something he has promised for years — but offered few details beyond his idea for providing Americans with stipends to help buy insurance.

“I want to see the billions of dollars go to people, not to the insurance companies," Trump said late Friday during an event at the White House. “And I want to see the people go out and buy themselves great healthcare.”

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 the tax credits for those buying policies through Obamacare. It’s unclear how much money Trump envisions. The Senate GOP proposal that failed to advance would have provided payments to new health savings accounts of $1,000 a year for adult enrollees, or $1,500 for those ages 50 to 64.

It appeared there were no such health savings accounts in the new House GOP plan.

Political pressure is building for many

Going Johnson's route has left vulnerable House Republicans representing key battleground districts in a tough spot.

Frustrated with the delays, a group of more centrist GOP lawmakers is aligning with Democrats to push their own proposals for continuing the tax credits, for now, so that Americans don't face rising health care costs.

They are pursuing several paths for passing a temporary ACA subsidy extension, co-sponsoring a handful of bills. They are also signing onto so-called discharge petitions that could force a floor vote if a majority of the House signs on.

Such petitions are designed to get around the majority's control and are rarely successful, but this year has proven to be an exception. Lawmakers, for example, were able to use a discharge petition to force a vote on the release of the Jeffrey Epstein files held by the Department of Justice.

One petition, filed by Rep. Brian Fitzpatrick, R-Pa., had signatures from 12 Republicans and 12 Democrats as of Friday afternoon. It would force a vote on a bill that includes a two-year subsidy extension and contains provisions designed to combat fraud in the ACA marketplace. There are also restrictions for PBMs, among other things.

Another petition from Rep. Josh Gottheimer, D-N.J., has 39 signatures and is broadly bipartisan. It's a simpler proposal that would force a vote on a one-year ACA enhanced subsidy extension and would include new income caps limiting who qualifies for the enhanced credit.

Both discharge petitions have enough Republicans’ support that they would likely succeed if Jeffries encouraged his caucus to jump on board. So far, he's not tipping his hand.

“We’re actively reviewing those two discharge petitions and we’ll have more to say about it early next week,” Jeffries said.

Meanwhile, Jeffries is pushing Democrats' own discharge petition, which has 214 signatures and would provide for a clean three-year subsidy extension. No Republicans have signed onto 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.