House GOP Bill Targets Long-Term Health Premium Reductions, Excludes ACA Subsidies

Rep. Mariannette Miller-Meeks has introduced the "Lower Health Care Premiums for All Americans Act" in the U.S. House, targeting the reduction of rising health care premium costs without extending Affordable Care Act (ACA) subsidies. The legislation aims to address fundamental cost drivers by funding ACA cost-sharing reduction payments starting in 2027 and enhancing transparency requirements for pharmacy benefit managers. Additionally, it expands access to Association Health Plans, allowing more employers and self-employed individuals to benefit from group coverage options similar to those available to larger companies. The bill also modifies the definitions around stop-loss insurance and codifies CHOICE rules to enable employers to offer defined contributions for employee health coverage. The proposal prioritizes empowering patients and doctors in health care decisions over insurer profits and seeks to lower premiums by tackling underlying cost causes rather than relying on subsidy extensions. This approach contrasts with current ACA enhanced premium tax credits, which are set to expire and which Republicans argue merely funnel taxpayer funds to insurers without controlling overall costs. Previous efforts to extend these subsidies in the Senate have failed, alongside alternative measures such as Health Savings Account funding proposals for ACA marketplace enrollees. Critics from the Democratic side argue the bill does not provide sufficient mechanisms to prevent premium increases if ACA subsidies end and suggest that Miller-Meeks' initiatives may reduce access to care, especially in rural areas. Despite this, the legislation has been scored by the nonpartisan Congressional Budget Office as potentially lowering premiums for up to half of exchange enrollees and other individuals. However, the bill’s chances are uncertain in the Senate, where bipartisan support is necessary to overcome the 60-vote threshold. Miller-Meeks emphasizes that while the bill does not maintain the current subsidy structure, it aims for sustainable premium reductions by addressing systemic cost drivers. She anticipates some bipartisan support and expresses confidence in the bill’s progress through the House Rules Committee and potentially the Senate. The ongoing debate reflects broader policy challenges in balancing immediate affordability via subsidies versus long-term cost containment strategies within the U.S. health insurance market.