House GOP Proposes Healthcare Reform Without ACA Subsidy Extension

House Republicans have introduced a healthcare legislative proposal focused on reducing costs and expanding coverage options without extending the Affordable Care Act (ACA) subsidies, which are set to expire on December 31. The expiration of these subsidies threatens to double premiums for approximately 24 million Americans, prompting urgent action in a closely divided Congress. The GOP bill includes provisions to increase transparency from pharmacy benefit managers to employers regarding prescription drug spending, rebates, and formulary decisions, along with funding to lower premiums by 2027, targeting low-income enrollees. The proposal also seeks to broaden coverage choices by expanding association health plans, enabling employers across various industries to pool resources for more affordable insurance. It aims to safeguard small and mid-sized employers from catastrophic claims by distinguishing stop-loss insurance from health insurance, and codifies rules allowing employees to use pre-tax income to purchase individual coverage. Despite these measures, the bill faces significant challenges in the Senate, where 60 votes are needed to advance, and the chamber is narrowly split. House Republicans highlight the need to address the rising costs and inefficiencies they attribute to the ACA, with Speaker Mike Johnson characterizing the system as broken due to increasing premiums, shrinking networks, and systemic waste and fraud. Meanwhile, Democrats advocate for a three-year extension of ACA subsidies to maintain premium affordability, opposing the Republican alternative. The legislative process includes a pending House Rules Committee decision on potential amendments such as subsidy extensions, with a full House vote anticipated soon. This legislative standoff underscores the ongoing partisan divide over healthcare policy, particularly concerning the future of ACA subsidies and market stability. The debate reflects broader concerns about healthcare affordability, employer-sponsored insurance dynamics, and regulatory frameworks impacting prescription drug costs and insurance access. Insurance professionals should monitor developments closely as the expiration of subsidies could significantly disrupt both individual markets and employer-based coverage options.