Here’s what’s in the House GOP health care bill
By Tami Luhby, CNN
(CNN) — House Republicans are set to vote this week on their version of a health care bill as the expiration of enhanced Affordable Care Act subsidies looms ever closer.
The legislation does not address that key premium assistance, though lawmakers may consider an amendment to the bill that would extend the enhanced subsidies. The details of such an amendment are still being discussed.
Whatever happens in the House, however, the beefed-up subsidies are likely to lapse at year’s end since the Senate is not expected to vote on any health care proposals this week. A Democratic effort to extend the subsidies was voted down in the Senate on Thursday, as was a Republican bill that would have funneled federal funds into health savings accounts, known as HSAs, to help certain Obamacare enrollees afford health care.
The House package would not beef up HSAs, but it does contain other measures that have long been popular with Republicans.
“This is kind of a greatest hits of Republican health care ideas of the last decade,” said Larry Levitt, executive vice president for health policy at KFF, a nonpartisan research group.
If the enhanced subsidies lapse, enrollees will see their annual premium payments increase by 114% — or about $1,000 — on average in 2026, according to KFF. Roughly 2 million more people are also expected to be uninsured next year if the subsidies end, according to the Congressional Budget Office. The more generous assistance was enacted in 2021 as part of a Biden administration Covid-19 relief package.
Here’s what’s in the House GOP health care bill:
Association health plans
The House bill would allow small businesses — as well as self-employed people — to band together across industries to buy coverage through association health plans in an effort to lower premiums.
President Donald Trump attempted to expand these plans in his first term before being blocked in federal court. The rule aimed to allow small businesses and the self-employed to unite based on their industry or location and buy coverage. It was another way the president tried to undercut the Affordable Care Act. The rule was eventually rescinded by the Biden administration.
Association health plans can’t exclude people with preexisting conditions or charge them higher premiums, which are two of the most popular protections enacted by the Affordable Care Act. However, the plans have features that favor healthier consumers. For instance, they are not required to provide the same robust coverage as Obamacare plans, and they don’t have limits on how much more they can charge older enrollees, who tend to have more costly health conditions.
Beefing up association health plans is one way Republicans have sought to provide cheaper but less comprehensive policies for healthier people, Levitt said.
Cost-sharing subsidies
The House bill would once again provide federal funding for the cost-sharing subsidies that lower-income Obamacare enrollees receive to reduce their deductibles and out-of-pocket costs for care.
Trump stopped paying insurers to provide the subsidies during his first term in an effort to weaken the Affordable Care Act. However, the landmark health reform law requires insurers to provide the reductions, so they hiked the premiums of silver plans on the exchange, a practice known as silver loading. (Obamacare offers four main plan tiers – bronze, silver, gold and platinum – that have different premium and out-of-pocket expense levels.)
This increased the amount the federal government had to spend on premium subsidies — but it also benefited enrollees, who received more assistance to purchase different levels of coverage on the Obamacare exchanges.
Funding the cost-sharing subsidies would reduce silver plan premiums, but it would also slash the aid enrollees receive to pay for coverage, in effect raising their monthly payments while lowering the federal government’s obligation. And it would come at a time when consumers are already contending with the lapse of the enhanced premium subsidies.
Those with moderate incomes would see a big premium increase, said Loren Adler, associate director at the Brookings Institution’s Center on Health Policy. Payments would rise for those who want to purchase other levels of plans.
“There are very few winners from this policy,” he said, adding that the CBO estimated earlier this year that 300,000 more people would be uninsured in 2034 if a similar measure proposed as part of Trump’s landmark policy bill had been approved.
Also, the cost-sharing subsidy funding could not go to any plans that cover abortion, which would effectively ban the procedure in Obamacare plans, Levitt said. That’s a nonstarter for Democrats.
Pharmacy benefit managers
House Republicans would require pharmacy benefit managers, which act as middlemen between drugmakers and insurers or employers, to provide employers with data on the price of drugs, the rebates they receive from manufacturers and other operations. It’s an effort to bring more transparency into an opaque part of the prescription drug supply chain that has been blamed for the high cost of medications. But it is unlikely to have much of an impact on the industry, experts said.
PBM reform has had bipartisan support in Congress, and Trump has also targeted PBMs. A more comprehensive bipartisan overhaul 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.
Choice accounts
The House bill would codify a regulation from the first Trump administration that allows employers to provide their workers with tax-free funds to buy coverage on the Obamacare exchange.
Critics are concerned that this measure could result in more sicker employees in Obamacare policies, which would raise premiums. Also, it could place more of the risk of rising rates on workers if their employers’ contributions don’t keep pace.
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