House set to vote this week on GOP health bill without ACA subsidy extension; GOP Rep. Kiley backs temporary extension
The House is set to vote this week on a GOP health-care package that omits an extension of the enhanced ACA premium tax credits, even as moderates and bipartisan groups press for a short-term fix and analysts warn millions could face much higher premiums if the subsidies lapse. Speaker Mike Johnson has declined to guarantee a House vote on an extension, prompting discharge-petition threats and intra-GOP splits — while Rep. Kevin Kiley and some other Republicans say they support a temporary extension amid ongoing shutdown and appropriations negotiations in the Senate.
📌 Key Facts
- The House is scheduled to vote this week on a GOP health-care package (a 111‑page 'Lower Health Care Premiums for All Americans Act') that does not extend the expiring enhanced ACA premium tax credits and instead includes expansion of association health plans, new pharmacy benefit manager (PBM) transparency rules, funding/codification of cost‑sharing reduction payments, and measures to make it easier for small businesses to buy coverage.
- Speaker Mike Johnson and House GOP leaders say they will bring the bill forward and permit an amendment vote on extending ACA subsidies to appease moderates, but Johnson has refused to guarantee a House vote to extend the enhanced subsidies and many conservatives and the Republican Study Committee oppose any extension.
- Bipartisan groups and moderates in the House (including Gottheimer–Kiggans and Fitzpatrick–Suozzi) have put forward one‑ and two‑year temporary extension proposals with income caps and anti‑fraud guardrails; Rep. Brian Fitzpatrick and other moderates have filed or threatened discharge petitions to force a House vote on a multi‑year extension.
- At least one House Republican, Rep. Kevin Kiley, publicly supports a temporary extension of the enhanced premium tax credits to prevent more than 20 million people who rely on them from facing higher costs or losing coverage.
- Senate and White House activity: Senate Majority Leader John Thune has guaranteed Democrats a Senate vote on an ACA subsidy proposal though any bill would likely face a 60‑vote threshold; the White House circulated a draft two‑year extension with a 700% FPL cap and minimum premium requirement, while some Senate and House Republicans (including Bill Cassidy and others) have proposed redirecting subsidy funds into HSAs or direct payments to enrollees.
- Nonpartisan analyses warn of steep consequences if enhanced subsidies lapse: the CBO estimated about 2 million people could lose insurance next year and estimated extending the credits would cost roughly $23 billion in the next year and nearly $350 billion over 10 years; KFF and other analyses project large premium increases (KFF estimates an average ~26% rise in 2026 and some analyses say premiums could more than double for many).
- Timing and urgency are high: open enrollment is underway (most states' Dec. 15 deadline for Jan. 1 coverage, Jan. 15 in some states), the enhanced subsidies expire at year‑end, and House leaders face a Dec. 18 final scheduled session day — pressures that have driven moderates to push for quick votes this month.
- The subsidy dispute is tied to broader negotiations that grew out of earlier government shutdown talks — Democrats demanded a guaranteed or immediate subsidy extension as a condition to reopen government, while Republicans have pushed short‑term fixes paired with reforms (income caps, minimum premiums, Hyde language) and remain divided over whether to extend the current subsidy structure.
📊 Analysis & Commentary (5)
‘Affordability’ Costs a Bundle
"The op‑ed criticizes Democratic calls for new government spending to address affordability—arguing it's hypocritical for the party to propose more programs as a remedy for higher costs their policies helped create and expressing skepticism that more government spending will solve the problem."
Trump’s ‘new’ healthcare idea is a painful prescription for working Americans
"The piece is a critical opinion response to proposals (advocated by Trump and allies) to replace ACA premium tax credits with direct cash or HSA payments, arguing the change would favor the wealthy, push people into high‑deductible plans, raise out‑of‑pocket risk, destabilize the ACA marketplaces, and harm working Americans."
The Republican Health Care Trilemma
"Josh Barro argues that Republican health‑care rhetoric ignores an unavoidable trilemma — you cannot simultaneously reject mandates, reject subsidies, and preserve protections for those with pre‑existing conditions — explaining why GOP leaders (and the shutdown debate over ACA subsidies) lack a coherent policy."
Republicans Don’t Have a Health Care Trilemma
"A Manhattan Institute commentary argues that Republicans need not accept an impossible 'trilemma' over the fate of enhanced Obamacare subsidies — instead they should pragmatically avert a lapse (or offer a short extension) to avoid voter harm and use negotiations to pursue market‑oriented reforms, while warning that President Trump’s demand for immediate direct payments is impractical and politically risky."
What’s left for 2025
"The Politico newsletter surveys the final‑week Washington calendar and zeroes in on the high‑stakes fight over expiring enhanced ACA subsidies — noting a House GOP package that omits an extension, an anticipated amendment vote to avert premium spikes, and broader political dynamics that make a last‑minute bipartisan fix uncertain."
📰 Sources (63)
ACA shoppers face sticker shock as Congress dithers on health care
New information:
- Details the House GOP package contents: expanded association health plans, appropriations for cost-sharing reduction payments to stabilize the market, and enhanced PBM transparency requirements.
- Confirms the House package does not extend enhanced ACA subsidies and notes White House has not chosen among competing Hill plans.
- Emphasizes enrollment deadlines (Dec. 15 for Jan. 1 coverage in most states; Jan. 15 for Feb. 1 coverage) increasing urgency.
GOP Rep. says ACA subsidy users shouldn't 'pay the price for congressional inaction'
New information:
- Rep. Kevin Kiley publicly criticizes Speaker Mike Johnson’s plan as 'hastily thrown together' and not addressing 'the crisis in front of us.'
- Kiley says he supports a temporary extension of ACA premium tax credits so 'more than 20 million' relying on them don't 'pay the price for congressional inaction.'
- NPR reports the House is set to vote this week on a plan that does not include extending the expiring credits.
After failure in the Senate, House GOP has its own health care proposal
New information:
- House GOP bill would allow small businesses to band together to buy insurance (association health plans).
- It adds new requirements on pharmacy benefit managers aimed at lowering drug costs.
- Starting in 2027, federal cost-sharing reduction payments would be used to lower premiums for some low-income enrollees, with an exclusion for plans covering abortion.
- Unlike the Senate GOP plan, the House package does not include HSA deposits for people up to 700% of the federal poverty level.
- Speaker Mike Johnson says a House vote is expected next week; Minority Leader Hakeem Jeffries publicly opposes the plan.
- President Trump reiterated he prefers directing money to people instead of ACA tax credits to insurers.
House GOP unveils health care plan, with vote on track for next week
New information:
- House GOP formally unveiled the package Friday.
- House Rules Committee will take up the bill Tuesday afternoon.
- A potential floor vote could come as soon as Tuesday evening or Wednesday.
- GOP leaders will allow a vote on an amendment to extend expiring ACA tax credits to appease moderates pushing discharge petitions.
- Speaker Mike Johnson issued a statement framing the bill’s aim and criticizing Democrats.
House GOP unveils healthcare plan ahead of vote next week as cost hike looms for millions
New information:
- House GOP leadership aides now expect a vote next week on extending enhanced ACA subsidies via an amendment to the bill.
- The package is a 111-page 'Lower Health Care Premiums for All Americans Act.'
- Republicans say appropriating cost-sharing reductions beginning in 2027 would lower premiums by about 12%.
- Bill details reiterated: codifies association health plans and adds PBM transparency requirements.
- House Minority Leader Hakeem Jeffries said Democrats will evaluate proposals that provide certainty to those at risk of losing coverage.
House GOP details health plan for vote next week
New information:
- Base House GOP plan omits an extension of enhanced ACA premium subsidies.
- Package includes expansion of association health plans for group purchasing.
- Adds new transparency measures on pharmacy benefit managers aimed at lowering drug costs.
- Funds ACA cost-sharing reduction (CSR) payments, which would lower overall premiums but also reduce some enrollees’ subsidy amounts.
- Includes provisions to ease small businesses’ ability to purchase health coverage.
- Leadership expects a separate amendment vote on some form of ACA subsidy extension next week, but it is unlikely to pass.
- Senate GOP concept to provide $1,000–$1,500 HSA funds as an alternative is not included; further proposals could get votes early next year.
Moderate Republicans buck leadership with bid to force vote on Obamacare subsidies as premium cliff looms
New information:
- Rather than wait for leadership, moderates initiated a discharge petition to compel a vote on extending enhanced ACA subsidies.
- At least eight initial signers (6 Republicans, 2 Democrats) are on the petition, indicating growing intra-GOP pressure.
- Speaker Mike Johnson has shown little appetite for the plan, per the article, underscoring caucus divisions.
House GOP moderates revolt against Johnson on health care
New information:
- Rep. Brian Fitzpatrick introduced a discharge petition to force a House vote on a two-year extension of ACA premium tax credits through 2027.
- A small group of GOP moderates quickly signed the petition, which would need 218 signatures and likely most Democrats to succeed.
- Fitzpatrick’s plan adds an income cap for eligibility, expands access to HSAs, and imposes a small monthly premium on the lowest-income beneficiaries to deter fraud.
- Speaker Mike Johnson said leadership has tried to find a path but lacks sufficient Republican votes and promised to unveil a path forward next week.
- House leaders face a Dec. 18 deadline, the last scheduled session day this year.
Republicans are torn over health care. Here’s what we know
New information:
- Identifies a specific bipartisan House bill — the "Bipartisan Health Insurance Affordability Act" led by Reps. Brian Fitzpatrick and Tom Suozzi — released on Dec. 9 to extend enhanced ACA subsidies.
- Details of the House "CommonGround" framework: a one‑year extension, open enrollment extended to March 19, 2026, and a phased subsidy reduction for incomes between 600% and 1,000% of FPL.
- Clarifies GOP leadership split: Sen. John Thune backing an HSA approach while President Trump and Speaker Mike Johnson have not endorsed a plan.
- Cites KFF analysis that premiums would, on average, more than double in 2026 for enrollees currently aided by the enhanced subsidies if they expire.
House GOP struggles to craft health care plan with tax credits set to expire
New information:
- Steve Scalise said the House will vote next week on 'a number' of health bills aimed at lowering premiums, while acknowledging there is no full conference consensus yet.
- House leaders have not committed to a direct vote on extending ACA tax credits before Dec. 18, the chamber’s last scheduled day this year.
- Rep. Mike Flood said Republicans will not support a 'clean extension' of the subsidies without reforms.
- Details of bipartisan House frameworks: Gottheimer–Kiggans plan for a one‑year extension with income limits and a second year adding reforms (ending $0 premiums with need‑based exceptions); Fitzpatrick plan to extend credits through 2027 with an income cap, expand HSAs, and require small monthly premiums for lowest‑income enrollees.
- Rep. Brian Fitzpatrick is weighing a discharge petition to force a vote on his bipartisan plan as a last resort.
- Impact estimates cited: CBPP says average premiums would rise by over $1,000 annually without credits; KFF estimates average annual premiums would more than double from $888 in 2025 to $1,904 in 2026.
Bipartisan lawmakers unveil Obamacare extension as pressure grows on Johnson for play call
New information:
- A bipartisan House group led by Reps. Brian Fitzpatrick (R-Pa.) and Tom Suozzi (D-N.Y.) introduced legislation to extend enhanced ACA premium tax credits for two years.
- Named co-sponsors include Reps. Don Bacon (R-Neb.), Rob Bresnahan (R-Pa.), Jared Golden (D-Maine), Don Davis (D-N.C.), and Marie Gluesenkamp Perez (D-Wash.).
- The bill would require enrollee consent and prompt notification before any plan or subsidy changes take effect.
- It includes reforms to rein in pharmacy benefit manager (PBM) profits and expands access to health savings accounts (HSAs).
- Fitzpatrick characterized the bill as a 'practical, people-first fix' to avoid premium spikes while longer-term reforms are debated.
Swing district Republicans brace for political fallout if health care subsidies expire
New information:
- A new bipartisan House proposal unveiled Thursday has backing from roughly 15 Republicans and 20 Democrats to temporarily extend ACA enhanced premium tax credits.
- Thirteen House Republicans (including Rep. Ryan Mackenzie) sent an October letter urging Speaker Mike Johnson to pursue a temporary extension, warning of harm if subsidies lapse without a path forward.
- Speaker Mike Johnson has not committed to a short-term extension vote before Jan. 1 and has downplayed the scope of affected Americans.
- Rep. Jen Kiggans (R-VA) said about 40,000 people in her district rely on ACA coverage and is co-sponsoring the bipartisan plan; Rep. Mackenzie publicly supports a pragmatic extension while seeking cost reforms.
- AP notes Democrats plan to make potential premium hikes a 2026 campaign issue, tying them to Trump-era GOP policies.
SCOTUS case could expand presidential powers. And, Dems pitch plan for ACA subsidies
New information:
- Speaker Mike Johnson plans to release a health care bill this week and promises a House vote on ACA subsidies this month.
- Johnson is not negotiating with Democrats on his bill.
- President Trump has not endorsed any ACA tax‑credit legislation.
Republicans have a mess on their hands over health care subsidies
New information:
- Speaker Mike Johnson hopes to unveil a House GOP health package early next week, though some doubt it will materialize.
- Majority Leader Steve Scalise has been holding ‘listening sessions’ with committee leaders and rank-and-file to find a House GOP consensus.
- Rep. Brian Fitzpatrick is floating a plan mirroring a White House proposal that was postponed after conservative pushback.
- Reality check: a sizable GOP bloc remains opposed to any extension; a GOP-only plan likely cannot pass and a suspension route would require ~80 Republican votes.
GOP unveils plan for 'Trump Health Freedom Accounts' to replace Obamacare subsidies with state waivers
New information:
- Specific vehicle identified: 'The More Affordable Care Act' by Rep. August Pfluger, branding HSA conduits as 'Trump Health Freedom Accounts.'
- Operational details: state ACA waiver pathway, private or state‑run exchange options, and mandated availability across waiver states.
- Timing: Filing planned Monday; uncertain inclusion in the House GOP health-care package Speaker Johnson aims to move this month.
Scalise announces GOP healthcare overhaul coming in 'next few weeks' amid battle over expiring subsidies
New information:
- House Majority Leader Steve Scalise said Republicans will bring 'a number of bills' to the House floor in the 'next few weeks,' not next year.
- Scalise outlined goals to lower costs and expand consumer choice, including removing legal barriers so small businesses can pool buying power and access more plan types (association health plans).
- He added Republicans will also bring prescription drug pricing bills and challenged Democrats to back GOP proposals amid expiring enhanced ACA subsidies.
Bipartisan House group pushes new ‘CommonGround 2025' healthcare framework
New information:
- A bipartisan group formally unveiled the 'CommonGround 2025' framework, co-led by Reps. Josh Gottheimer and Jen Kiggans.
- The plan calls for a one-year extension of the ACA enhanced premium tax credits with targeted modifications and anti-fraud guardrails aimed at preventing 'ghost beneficiaries.'
- Thirty-five House members signed a letter to congressional leaders urging consideration and seeking House and Senate votes by Dec. 18.
- Rep. Mike Lawler highlighted subsidy levels and framed the effort as addressing concerns about temporary COVID-era credits.
- Rep. Gottheimer warned that if credits lapse, premiums could rise an average 26% next year, with New Jersey potentially seeing increases up to 175% ($20,000 for a family of four).
House GOP splits over Obamacare fix as costs poised to spike for millions
New information:
- Speaker Mike Johnson told Bloomberg the House will vote on a healthcare plan by the end of this month.
- A bipartisan Kiggans–Gottheimer framework was released Thursday proposing a one‑year extension of enhanced ACA subsidies followed by a modified plan with continued premium savings and broader reforms.
- Reps. Tom Suozzi and Brian Fitzpatrick plan to introduce a two‑year extension bill with targeted reforms as soon as Thursday.
- House Majority Leader Steve Scalise said timing is uncertain but leaders are building a coalition across GOP factions.
- Conservatives such as Rep. Chip Roy remain opposed to extending the current subsidy structure.
- Framework details include new guardrails to curb fraud and inactive enrollments and added income requirements.
Bipartisan deal on Obamacare subsidies fades as Republicans push HSA plan
New information:
- Details the Senate GOP counterproposal led by Sen. Bill Cassidy to shift funding to pre-funded HSAs (~$2,000 per account) instead of insurer-paid subsidies.
- Signals bipartisan talks have slowed and are unlikely to produce agreement by next week’s vote; possible side-by-side vote lacks support.
Health care proposal floated by White House runs into familiar GOP divisions
New information:
- Specifics of the White House draft: two-year extension, 700% FPL cap, and required premiums for all plans.
- New lawmaker reactions on the record (Tillis, Shaheen, Flood) indicating some bipartisan openness despite House GOP resistance.
- Acknowledgement that the White House has not committed to formally releasing the plan.
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