House GOP unveils narrow health care package with key deadline looming

By Sarah Ferris, Adam Cancryn, Tami Luhby, CNN

(CNN) — House Republicans unveiled a narrow health care package on Friday that does not extend soon-to-expire enhanced Affordable Care Act subsidies — the latest sign that Congress is unlikely to avert skyrocketing insurance premiums for millions of Americans in the new year.

The GOP proposal would instead seek to expand the availability of association health plans, which allow employers to band together to purchase coverage, and fund a cost-sharing reduction program meant to lower premiums for certain Affordable Care Act enrollees. It would also impose new transparency requirements on pharmacy benefit managers in a bid to lower drug costs.

GOP leaders opted against extending the enhanced subsidies as part of their highly anticipated plan, according to multiple Republican leadership aides. But they do expect to allow a floor vote on an amendment related to those subsidies, which are set to expire at the end of the month. The precise details of that amendment are not yet clear but are being hashed out by centrist GOP Rep. Brian Fitzpatrick of Pennsylvania and others.

“While Democrats demand that taxpayers write bigger checks to insurance companies to hide the cost of their failed law, House Republicans are tackling the real drivers of health care costs to provide affordable care, increase access and choice, and restore integrity to our nation’s health care system for all Americans,” Speaker Mike Johnson said in a statement on Friday.

The GOP’s intraparty fight over the fate of the Obamacare subsidies has consumed Congress for weeks, including an hours-long meeting of top House Republican leaders, centrists and hardliners earlier at the Capitol on Friday.

GOP leaders plan to put the package on the floor next week, which will be the House’s final work week of 2025. But it remains unclear whether the proposal has the support to pass out of the chamber, much less win over the entirety of the House Republican conference.

The release of the House GOP plan comes after the Senate tried and failed to pass dueling health care plans earlier this week, the latest sign of partisan stalemate over the issue.

House Minority Leader Hakeem Jeffries said earlier on Friday, “Their health care package, as I understand it, is likely to be a disaster and actually not enhance the health care of the American people. It will take away from it. So it’s not clear to me that even if it’s amended to include whatever Fitzpatrick has proposed that it will actually solve the problem of addressing the Republican health care crisis.”

House GOP leaders are bundling a handful of smaller-scale health care bills that have been pillars of Republican health policy since their first attempt to replace Obamacare in 2017. That includes restoring a cost-sharing reduction program that would help offset costs for lower-income people by requiring insurers to pay more, as CNN reported earlier this week.

The proposal also seeks to codify existing rules allowing employers to offer defined contribution plans such as health savings accounts. But it stops well short of the broader HSA expansion that President Donald Trump has called for, which would involve funneling federal aid directly to patients to help subsidize their health care costs.

“Every policy you’re going to see in this bill has received a vote in the House under a Republican majority, and every provision has had bipartisan support in the past,” one GOP leadership aide said Friday.

Trump during a Friday night event in the Oval Office did not address the House GOP plan directly. But he reiterated his demand for diverting federal aid to people through HSAs, saying he wants “to give the money to the people and let the people buy their own great health care.”

“Hopefully, they’re going to put great legislation on this desk right here,” Trump said of congressional Republicans.

Absent such a major proposal, the GOP’s plan for reducing people’s health premiums centers mainly on restoring the ACA’s cost-sharing reduction payments. Republicans effectively halted those payments during the first Trump administration as part of an extended legal battle, and amid the party’s failed efforts to repeal and replace the 2010 health law. The loss of those funds prompted health insurers to adopt a complicated practice called “silver loading” that raised premiums — yet also expanded federal subsidies granted to enrollees. Conservatives, as a result, have now sought to re-fund the cost-sharing reduction program as a way of limiting federal spending on the ACA’s subsidies.

Under the plan, the cost-sharing payments then go to the consumer to help pay out-of-pocket costs, such as deductibles and co-payments, for lower-income people on Obamacare plans. But the money does not go toward those Obamacare premiums, which are set to spike for millions of Americans next year once the Biden-era subsidies expire.

If those enhanced subsidies lapse, enrollees will see their premium payments more than double — or about $1,000 — on average, according to KFF, a nonpartisan health policy research group. Roughly 2 million more people are also expected to be uninsured next year if the funding lapses, according to the Congressional Budget Office.

The House GOP plan also recycles another longstanding health care priority, association health plans, which Trump attempted to expand in his first term before being blocked in federal court. The rule aimed to allow small businesses and the self-employed to band together based on their industry or location and buy health insurance in an effort to lower premiums. The move was another way the president tried to undercut the Affordable Care Act.

The efforts to inject more transparency into pharmacy benefit managers — which serve as middlemen between drug manufacturers and insurers — has had bipartisan support in Congress. Trump has also called to reform PBMs, which have been blamed by multiple parties as pushing up drug prices for patients.

A bipartisan PBM reform measure looked close to passage last December, when it was included in a short-term government funding plan. But the massive funding package was torpedoed by billionaire Elon Musk and Trump.

This story has been updated with additional details.

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CNN’s Tami Luhby and Arlette Saenz contributed to this report.