House GOP Health Bill Faces Uphill Battle as Subsidies Loom Over Millions
The House of Representatives is poised to vote this week on a Republican healthcare proposal as critical Affordable Care Act (ACA) subsidies are set to expire, potentially impacting millions of Americans. While the legislation addresses several long-held Republican priorities, it does not directly tackle the expiring premium assistance, though lawmakers are considering amendments to extend them.
The future of the enhanced subsidies remains uncertain, with the Senate unlikely to take up any healthcare proposals this week. A Democratic attempt to extend the subsidies failed on Thursday, as did a Republican measure focused on health savings accounts (HSAs). This leaves the fate of the subsidies hanging in the balance as the year-end deadline approaches.
If the enhanced subsidies lapse, the Kaiser Family Foundation (KFF) estimates that enrollees will see their annual premium payments increase by 114% – roughly $1,000 on average – beginning in 2026. The Congressional Budget Office (CBO) projects that approximately 2 million more people could become uninsured next year if the assistance ends. These subsidies, enacted in 2021 as part of a Biden administration COVID-19 relief package, have been instrumental in maintaining affordable coverage.
A “Greatest Hits” of Republican Healthcare Ideas
According to one health policy expert, “This is kind of a greatest hits of Republican health care ideas of the last decade.” The House bill focuses on several key areas favored by the GOP, but notably avoids bolstering HSAs.
One central component of the bill would allow small businesses and self-employed individuals to join together across industries to purchase coverage through association health plans. This approach, previously attempted during the Trump administration but blocked by a federal court, aims to lower premiums by expanding the risk pool. However, these plans often offer less comprehensive coverage than ACA plans and may allow for higher premiums for older enrollees.
Cost-Sharing Subsidies and Potential Complications
The House bill also proposes reinstating federal funding for cost-sharing subsidies, which reduce out-of-pocket expenses for lower-income ACA enrollees. While this would lower premiums on silver plans, it would simultaneously reduce the financial assistance available to help individuals afford coverage overall.
Loren Adler, associate director at the Brookings Institution’s Center on Health Policy, cautioned that “there are very few winners from this policy.” The CBO previously estimated that a similar measure could lead to 300,000 more uninsured Americans by 2034. Furthermore, funding for these subsidies would be prohibited from going to plans that cover abortion, a provision that is expected to be a non-starter for Democrats.
PBM Transparency and Employer-Sponsored Coverage
The legislation also targets pharmacy benefit managers (PBMs), requiring them to disclose data on drug pricing and rebates to employers. This aims to increase transparency in the prescription drug supply chain, though experts suggest the impact may be limited. PBM reform has garnered bipartisan support, but previous attempts at comprehensive overhaul have stalled, notably being blocked last December by external forces.
Finally, the House bill would reinstate a Trump-era regulation allowing employers to provide tax-free funds to help workers purchase coverage on the ACA exchange. Critics worry this could shift sicker employees into ACA policies, driving up premiums and potentially increasing financial risk for workers if employer contributions don’t keep pace with rising costs.
