Vulnerable Republican blasts choice to send health insurance spiking as ‘political malpractice’

House Speaker Mike Johnson discussed the possibility of allowing more politically vulnerable GOP lawmakers the opportunity to vote on their amendment that would temporarily extend pandemic-era subsidies to cover the ACA. But after days of private talks, leadership sided with the more conservative wing of the conference, which attacked the subsidies as propping up the failed ACA.

“We looked for a way to try to allow a pressure release valve,” Johnson said Tuesday at the Capitol. “In the end, that was not the case, and no agreement was reached.”

The maneuvering surrounding the health care vote ensures that many Americans will see much higher insurance costs in 2026. In the Senate, a bipartisan group was still trying to reach a compromise to expand subsidies, leading to a government shutdown this year. But senators made clear that any potential legislation would likely have to wait until January, after the holiday recess.

Instead, House Republicans will pursue a more than 100-page health care package that focuses on long-awaited GOP proposals designed to expand insurance coverage options for small businesses and the self-employed. A test vote is expected on Wednesday.

The Republican package would crack down on middlemen called pharmacy benefit managers who work to manage drug costs and process claims for insurance plans. The bill would also expand access to what are referred to as association health plans, which would allow more small businesses and self-employed individuals to band together and purchase health coverage.

An analysis by the nonpartisan Congressional Budget Office and the Joint Committee on Taxation estimates that the package would reduce the number of people with health insurance by an average of 100,000 annually over the period 2027-2035, while reducing the federal deficit by $35.6 billion.

Failure to address expired insurance benefits as “political malpractice.”

Rep. Mike Lawler, R-N.Y., criticized leadership’s decision to not allow a vote on temporarily extending health insurance benefits, saying it amounts to “political malpractice.”

Lawler, who comes from a competitive district, noted that most people who get health coverage through the Affordable Care Act live in states won by President Donald Trump, and said the changes proposed for the temporary extension are “conservative reforms.” He also criticized Democratic Leader Hakeem Jeffries for not pushing Democrats to support a pair of bipartisan extension efforts.

“You have two leaders who are not serious about solving this problem,” Lawler said of Johnson and Jeffries.

However, centrist Republicans indicated they would not try to block a vote on the measure taken by Republican leadership.

Johnson defended the House Republican bill, which includes priorities that Republicans have been working on for several years.

“We have a long list of things that we know will lower premiums and increase access and quality of care,” Johnson said. “Democrats have zero ideas, zero concepts, and zero legislative plans for anything they would propose other than just shoring up a broken system.”

Democrats said that even if the bill was approved in the House, it would not pass the Senate, where it would need 60 votes and bipartisan support to move forward. They said it was not a serious attempt to address rising costs.

“Millions will be cut from their coverage, and those who can still afford it will get less while paying more,” said Rep. Susan DelBene, head of the House Democratic campaign arm. “Republicans are ignoring the pain, the pain we’re seeing across the country for ordinary Americans. Make no mistake, this will cost them the majority.”

The GOP bill focuses on insurance and cost-sharing options

During Trump’s first term, his administration sought to expand access to association health plans that do not have to offer the full list of benefits required under current law. The option offers lower premiums for small businesses and the self-employed, but policies are likely to cover fewer benefits. A federal judge who invalidated the administration’s efforts in 2018 said the plans were “clearly a dead end” around consumer protections required by the Affordable Care Act, also known as Obamacare.

House Republicans’ plan would also restore government funding for cost-sharing reductions, or CSRs, a type of financial assistance that insurance companies provide to low-income ACA enrollees in silver-level plans that reduces their share of costs such as deductibles and copayments.

From 2014 through 2017, the federal government reimbursed insurers for CSR — but in 2017, the Trump administration stopped making those payments. To make up for the lost money, insurers raised premiums on silver-level plans — a complicated move that ultimately increased the financial assistance many enrollees get to help pay their premiums.

As a result, health analysts say that while restoring funding for corporate social responsibilities would likely lower silver premiums, it could also have the unwelcome ripple effect of increasing net premiums for many people on bronze and gold plans.

The provisions regarding pharmacy benefit managers require brokers to disclose certain data about their processes for aggregating health plans, in the hope that greater transparency will reduce prescription drug costs.

Senators revive labor talks in the new year

Nearly two dozen Republicans and Democrats gathered late Monday to talk about a last-minute fix on the ACA tax credits after the Senate rejected two partisan health care bills last week. They left the meeting to discuss ways to end the impasse, including the possibility of a two-year extension of support with reforms that would narrow the scope of who can get it. They also discussed adding some version of a GOP proposal to create new health savings accounts that would help people buy insurance.

Maine State Sen. Susan Collins, a Republican who led the bipartisan meeting, said the group would like to announce a proposal this week. But major issues remain unresolved, including whether stricter language on abortion funding should be included. Disagreements over abortion were one of the main sticking points in previous talks that derailed the settlement.

Senate Majority Leader John Thune said there was a “potential path” to reaching a deal in January, but acknowledged “we’re not going to pass anything by the end of this week.”

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Staff writers Mary Clare Jalonick and Ali Swenson contributed to this report.