House passes GOP healthcare bill as ACA subsidies near December 31 expiration

WASHINGTON – The U.S. House of Representatives on Wednesday passed a Republican healthcare bill that would fund cost-sharing reduction payments and expand association health plans.

However, the legislation faces dim prospects in the Senate and does nothing to extend enhanced Affordable Care Act premium tax credits set to expire in two weeks—leaving more than half a million Ohioans facing dramatically higher insurance costs

The measure was adopted in a largely party-line 216 to 211 vote. Just one Republican, Kentucky’s Thomas Massie, joined Democrats in opposition.

The “Lower Health Care Premiums for All Americans Act” approved on Wednesday represents the House Republican alternative to simply extending the expiring ACA subsidies, as Democrats have proposed. The legislation would fund cost-sharing reduction payments starting in 2027, expand association health plans, increase pharmacy benefit manager (PBM) transparency, and codify rules for health reimbursement arrangements.

The Congressional Budget Office estimates that enacting the bill would reduce premiums by 11%, on average, through 2035, and would reduce the deficit by $35.6 billion over the 2026-2035 period. However, CBO also estimates the bill would decrease the number of people with health insurance by an average of 100,000 over the 2027-2035 period.

The GOP bill does not extend the enhanced premium tax credits that were expanded during the COVID-19 pandemic and are set to expire December 31, 2025.

According to the Kaiser Family Foundation, if those credits expire, subsidized enrollees currently paying an average of $888 annually in premiums would see that amount jump to $1,904 in 2026—a 114% increase. The Congressional Budget Office predicts 2.2 million people will lose insurance in 2026 without an extension, with that number rising to 3.8 million annually through 2034.

In Ohio specifically, approximately 583,000 residents could be affected by the subsidy expiration.

The GOP bill also includes an abortion coverage restriction, prohibiting cost-sharing reduction payments to plans that cover abortion except in cases of rape, incest, or to save the mother’s life.

During House floor debate, Iowa GOP Rep. Mariannette Miller-Meeks, the bill’s sponsor, said her plan would lower health care costs for everyone, “not just a select few, and not just to continue to subsidize profitable insurance companies.”

”It puts patients and doctors in the driver’s seat,” said Miller-Meeks, a physician. She said her bill would lower premiums by 11% through funding cost sharing reductions “not just through COVID era bailouts that benefited only big insurers.”

In a speech on the House of Representatives floor, Bay Village Republican Max Miller said that since the enactment of the “so-called Affordable Care Act,” health care costs have risen dramatically. He called the GOP bill “a critical step forward in curbing rising premiums, expanding choice and improving transparency.

“The legislation includes provisions to improve affordability, particularly for small businesses, along with cost sharing reduction funding and PBM reforms,” said Miller, adding that he remains “committed to reforming a broken health care system and increasing choice and competition to lower health care costs for our nation.:

Akron Democrat Emilia Sykes countered that the expiring subsidies would cause 22 million Americans’ health care premiums to double, triple or quadruple, “costing them hundreds of additional dollars a month, and more than 4 million Americans will lose their coverage entirely.” She estimated more than 12,000 people in her district will be affected.

She said she’s hearing “heartbreaking stories from my constituents who have no clue how they’re going to make ends meet as we enter into what should be a merry holiday season,” and argued that the bill’s abortion restrictions set “the stage for national abortion ban.”

“It is unacceptable that Congress is about to head home having done nothing, nothing to protect the millions of Americans who will lose coverage on January 1,” Sykes said, encouraging her colleagues “to extend credits before it’s too late.”

Discharge petition

In a significant procedural development, House Democrats succeeded Wednesday in gathering 218 signatures on a discharge petition that would force a vote on a three-year clean extension of the enhanced premium tax credit. The four Republicans who signed the petition were New York’s Michael Lawler and Pennsylvania’s Brian Fitzpatrick, Ryan Mackenzie, and Robert Bresnahan.

However, because of House procedural rules, the discharge petition cannot be acted upon until January when Congress returns from its holiday break, meaning the subsidies will expire before that vote can occur.

After the required waiting period in early January, the discharge petition would allow Democrats to bring their bill directly to the House floor for a vote, bypassing Republican leadership.

While Democrats urged House Speaker Mike Johnson to allow a House vote on Wednesday, he declined to do so.

Senate action last week

The U.S. Senate last week rejected multiple proposals to address the subsidy expiration. A Democratic plan to extend the enhanced premium tax credits for three years failed to reach the 60 votes needed for passage.

A separate Republican proposal from Senate Finance Committee Chairman Mike Crapo of Idaho and Senate HELP Committee Chairman Bill Cassidy of Louisiana—which would have provided direct payments to Americans enrolled in bronze or catastrophic plans through Health Savings Accounts and funded cost-sharing reduction payments but did not extend the premium tax credits—also failed to get 60 votes.

Both of Ohio’s Republican senators, Bernie Moreno and Jon Husted, voted against the Democratic extension and for the Crapo-Cassidy proposal.

Ohio senators’ competing proposals

Moreno-Collins Bill:

Sen. Bernie Moreno, a Westlake Republican, has introduced his own legislation with Sen. Susan Collins of Maine called the Consumer Affordability and Responsibility Enhancement (CARE) Act, which would extend the enhanced premium tax credits for two years while imposing new restrictions on eligibility.

The Moreno-Collins bill would cap subsidy eligibility at $200,000 in household income and require all enrollees to pay a minimum of $25 per month in premiums, eliminating the zero-premium plans currently available to lower-income Americans. Moreno described the extension as “a glidepath off the COVID-era subsidies” and accused Democrats of creating a disaster that lined “the pockets of massive insurance companies while healthcare costs for everyday Americans skyrocketed.”

The CARE Act represents one of the first GOP proposals to address the impending subsidy expiration, though it remains uncertain whether it can gain sufficient support in Congress.

Husted’s Alternative Plan:

Sen. Jon Husted, a Columbus-area Republican who faces a competitive re-election campaign against former Democratic Sen. Sherrod Brown in which health care has become a central issue, introduced his own bill this month called the Accountability for Better Care Act.

Husted’s legislation would also extend enhanced premium tax credits for two years while implementing reforms aimed at reducing fraud. The bill would require all enrollees to pay at least $5 per month in premiums (eliminating zero-premium plans, which Husted argues “invited fraud at the taxpayer’s expense”), extend subsidies to households earning up to 600% of the federal poverty level—$192,000 annually for a family of four—and fund cost-sharing reductions beginning in 2027 that could lower premiums by 10-20%.

Husted’s bill would also restrict enhanced premium tax credits to U.S. citizens only, ending eligibility for non-citizens who are lawfully present, and would incorporate Hyde Amendment protections preventing qualified health plans from covering abortions except in cases of rape, incest, or when the mother’s life is in danger.

The two Ohio senators’ bills have significant differences. Moreno’s sets a $200,000 household income cap and requires a $25 monthly minimum premium, while Husted’s sets a different income threshold—$192,000 for a family of four (600% of the federal poverty level)—and requires only a $5 monthly minimum payment. Husted’s proposal also includes the cost-sharing reduction funding and citizenship restriction provisions not present in Moreno’s legislation.

Whether either bill can gain traction in Congress remains uncertain, with only days remaining before the current enhanced subsidies expire at year’s end.