ACA subsidies are about to expire, and Congress still has no consensus solution

House Speaker 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 policies through the Affordable Care Act, also known as Obamacare, which expires at the end of the year. These subsidies help reduce the cost of coverage.

Johnson, R-Los Angeles, met behind closed doors in the morning — as he did earlier this week — to work on assembling 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 added that it will be voted on next week.

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

congress is running out of time to act. Democrats engineered the longest federal government shutdown ever this fall in a failed attempt to force Republicans to the negotiating table on health care. But after promising votes, the Senate failed this week to advance a GOP health care plan and a Democratic 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 compromise in sight.

What Republicans are proposing

House Republicans have offered a 100-page package focusing on long-sought GOP proposals to boost access to employer-sponsored health insurance plans and clamp down on so-called pharmacy benefit managers.

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

Supporters say such plans increase the leverage companies have to negotiate a lower price. But critics say the plans provide less coverage than required under the Affordable Care Act.

The Republicans’ proposal also would require more data from pharmacy benefit managers, or PBMs, as a way to help control drug costs. Critics say the PMS has boosted profits and made it difficult for independent pharmacists to survive.

Additionally, the GOP plan includes a reference to cost-sharing reductions for some low-income people who rely on Obamacare, but those reductions would not take effect until January 2027.

The emerging package from Republicans in the House of Representatives does not include extending the enhanced tax break for millions of Americans who obtain insurance coverage through the Affordable Care Act. Implemented during the COVID-19 crisis, this enhanced support expires on December 31, leaving most households in the program facing more than double their current out-of-pocket premiums, and in some cases, much more.

What does Trump want?

President Donald Trump said he believes Republicans will come up with a better plan than Obamacare — something he has promised for years — but offered few details beyond his idea of ​​providing Americans with stipends to help buy insurance.

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

The president did not comment directly on the House of Representatives’ new plan. He has repeatedly promoted his idea of ​​sending money directly to Americans to help offset the costs of health care policies, rather than extending tax breaks to those who buy policies through Obamacare. It is 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 annually for adult enrollees, or $1,500 for those ages 50 to 64.

There appear to be no such health savings accounts in the new House GOP plan.

Political pressures are increasing for many

Going Johnson’s way has left vulnerable House Republicans who represent key battleground districts in a difficult position.

Frustrated by the delay, a group of more centrist Republican lawmakers are allying with Democrats to push their own proposals to continue the tax breaks, for now, so Americans don’t face rising health care costs.

They are pursuing several paths to pass a temporary extension of support for the ACA, and are co-sponsoring a few bills. They also sign so-called recall motions that can be forced to vote if a majority in the House of Representatives falls.

Such petitions are designed to circumvent majority control and are rarely successful, but this year has proven to be an exception. For example, lawmakers were able to use the impeachment petition to force a vote on releasing the Jeffrey Epstein files held by the Justice Department.

One petition, filed by Rep. Brian Fitzpatrick, Republican of Pennsylvania, had signatures from 12 Republicans and 12 Democrats as of Friday afternoon. The vote would force a bill that includes a two-year extension of subsidies and contains provisions aimed at combating fraud in the ACA marketplace. There are also limitations on PBMs, among other things.

Another petition from Rep. Josh Gottheimer, D-N.J., has 39 signatures and has broad bipartisan support. It’s a simpler proposal that would force a vote on extending the ACA’s enhanced subsidies by one year and would include new income limits that limit who’s eligible for the enhanced credit.

Both recall petitions have enough Republican support and are likely to succeed if Jeffries encourages his caucus to join him. So far, he hasn’t raised his hand.

“We are actively reviewing these two discharge petitions and will have more to say on this matter early next week,” Jeffries said.

Meanwhile, Jeffries is pushing Democrats’ dismissal motion, which has 214 signatures, and which would provide a three-year extension of support. No Republicans signed on.

As Senate Republicans made clear this week, a three-year extension without changes to the program has no chance of passing the Senate.