Healthcare Reform Bill Set to Impact Insurance Premiums and Coverage Options
As of December 2025, House Republican leadership is advancing a healthcare bill that omits provisions to manage the anticipated surge in insurance premiums. This rise is expected following the expiration of pandemic-era tax credits under the Affordable Care Act (ACA). Discussions had taken place around allowing some GOP members to propose an amendment extending these subsidies temporarily. However, the leadership ultimately sided with party members opposing the subsidies, viewing them as upholding a challenged ACA marketplace.
This legislative move indicates that insurance costs will likely increase significantly for many in 2026. A bipartisan group in the Senate is working on a potential compromise to extend these subsidies, but any resolution is unlikely to occur before January. The uncertainty around regulatory compliance requirements adds concern for both insurance providers and payers.
The House's proposed healthcare bill emphasizes expanding insurance options for small businesses and self-employed individuals. It aims to implement long-standing Republican strategies, such as curtailing the influence of pharmacy benefit managers (PBMs) and broadening access to association health plans. These plans allow smaller entities and independent workers to collectively purchase health insurance, offering an alternative to traditional ACA plans.
According to projections from the Congressional Budget Office and the Joint Committee on Taxation, the Republican proposal could result in an average annual decrease of 100,000 insured individuals between 2027 and 2035, while reducing the federal deficit by $35.6 billion. A crucial component of the proposal is restoring government funding for cost-sharing reductions (CSRs) to assist low-income enrollees of silver-level ACA plans. While this could lower premiums for silver plans, it may also increase net premiums for bronze and gold plans due to shifts in financial assistance structures.
Provisions within the bill concerning PBMs involve enhancing transparency by mandating the disclosure of operational data to group health plans. This is intended to lower prescription drug costs through increased accountability. Improved risk management strategies and reduced costs are anticipated as additional benefits for insurance carriers.
A bipartisan group of nearly two dozen lawmakers continues to seek a resolution regarding the ACA tax credits. Discussions include potential extensions of these credits for two years, refining eligibility criteria, and considering the introduction of health savings accounts to facilitate insurance purchases. However, achieving consensus remains challenging, particularly concerning sensitive topics like abortion-related funding language.
These ongoing legislative efforts reflect complex dynamics in navigating healthcare reform. They are poised to impact the insurance industry, influencing insurers' operational strategies and premium determinations. As the industry prepares for regulatory changes, both providers and carriers must adapt to the evolving landscape in the upcoming year.