House GOP Proposes Healthcare Plan Amid ACA Subsidy Expiration

Health insurance premiums are expected to rise for at least 22 million Americans due to the expiration of enhanced tax subsidies for Affordable Care Act (ACA) marketplace plans at the end of 2024 unless Congress takes action. House Speaker Mike Johnson introduced a Republican alternative plan that does not extend these enhanced subsidies but focuses on expanding access to association health plans and increasing transparency in pharmacy benefit managers (PBMs). Association health plans aim to allow small businesses and self-employed individuals to pool together for coverage, potentially negotiating lower rates, though they may offer less comprehensive benefits than ACA plans. The Republican package also proposes requiring more data from PBMs to control drug costs and includes delayed cost-sharing reductions for some lower-income individuals, starting in 2027. However, this package does not address the immediate subsidy expirations, which could lead to significant premium increases for many. A group of centrist Republicans is working with Democrats to push for temporary extensions of the enhanced tax credits, using bipartisan discharge petitions to force House floor votes. These efforts aim to prevent premium shocks in 2026 by maintaining subsidies for one or two years, though success depends on leadership support. Meanwhile, Democrats continue to advocate for a clean three-year extension of the ACA subsidies, a proposal unlikely to pass the Senate in its current form. With limited time remaining in the congressional session, the health insurance coverage outlook for many Americans remains uncertain, underscoring ongoing partisan divisions over ACA-related policies and subsidy structures.