House GOP Health Care Plan Skips ACA Subsidy Extension — But Here's Why That Matters
The Republican leadership in the House is preparing to push a package of health care legislation next week — but notably, it will not include an extension of the enhanced ObamaCare subsidies set to expire soon. This omission highlights a growing divide within the GOP over how to handle the looming health care cliff, especially with a midterm election around the corner.
Speaker Mike Johnson (R-La.) told reporters that the upcoming legislation would consist solely of proposals "every Republican agrees to," all of which have been discussed in various House committees throughout the year.
"We’ve identified some low-hanging fruit that unites all Republicans," Johnson said during a press conference. "The package coming to the floor next week aims to reduce premiums for all Americans currently covered by health insurance."
However, the plan notably leaves out any provision to extend the expiring enhanced subsidies. Without an extension, millions of Americans could see their health insurance costs skyrocket by the end of the year.
After a House GOP conference meeting on Wednesday morning, House Majority Leader Steve Scalise (R-La.) admitted there was no consensus on extending the subsidies. "There wasn’t agreement," he said. "Right now, we need to focus on proposals that have full consensus because our majority is slim. That’s what we’ll be advancing."
Although leaders did not provide a detailed list of specific measures, they mentioned several ideas discussed in the Wednesday morning conference. They emphasized that these proposals would lower health care premiums broadly, not just for the 22 million Americans who currently benefit from the enhanced subsidies — which they pointed out represents only about 7% of the U.S. population.
The proposals on the table include expanding health savings accounts, allowing association health plans, reforming pharmacy benefit managers, and increasing price transparency. Some of these measures have enjoyed bipartisan support in the past, but a bill that ignores the expiring subsidies faces steep challenges in the Senate, where 60 votes are typically required to pass significant legislation.
Meanwhile, the Senate is preparing for a Thursday vote on competing health care plans from Republicans and Democrats — one aiming to extend the subsidies, and the other proposing to convert them into federally funded health savings accounts for high-deductible plans. Neither plan is expected to succeed.
Moderates and Republicans from competitive districts have advocated for extending the subsidies in some form. Rep. Kevin Kiley (R-Calif.) presented a bipartisan plan that would continue the subsidies for two years along with additional reforms. "The Speaker has heard it, and I hope he takes action," Kiley said. He noted that despite multiple bipartisan proposals in the House, leadership has not committed to supporting any temporary extension.
"The immediate issue is the cliff — if the subsidies expire, 22 million people will face much higher insurance costs," Kiley added. "Passing a law to prevent that must be our priority."
Resistance from some GOP members, however, remains strong. Critics argue the COVID-era enhancements, enacted under Democrats, were too expensive. Some insist that any subsidy extension must also expand Hyde Amendment protections against abortion coverage in ACA plans. "I would never consider any form of subsidy extension without Hyde protections," said Rep. Andy Harris (R-Md.), chair of the House Freedom Caucus.
Rep. Gregory Murphy (R-N.C.) reportedly urged colleagues not to use a discharge petition to bypass leadership and force a vote on extending subsidies. Yet Rep. Brian Fitzpatrick (R-Pa.) is exploring a discharge petition to push his two-year subsidy extension and reform bill, while House Minority Leader Hakeem Jeffries (D-N.Y.) is seeking moderate Republican support to extend subsidies as-is for three years.
This debate raises a critical question: Should lawmakers prioritize broad bipartisan reforms that lower premiums for all Americans, or focus narrowly on preventing immediate financial pain for millions reliant on expiring subsidies? The answer could have lasting implications for U.S. health care policy — and could be a decisive factor in the upcoming elections.
