GOP health bills could include site-neutral pay, high-risk pools

Modern Healthcare – Wednesday, December 10, 2025
By Michael McAuliff and Bridget Early

Republican leaders in the House of Representatives say they will vote on healthcare bills next week — but they have made no promises about the enhanced Affordable Care Act marketplace subsidies set to expire at the end of the year.

While Democrats on both sides of Capitol Hill are pushing for a simple three-year extension, GOP leaders have declined to embrace any continuation for the enhanced tax credits.

Instead, they are floating a range of other potential ideas, including the “site-neutral” Medicare reimbursements for outpatient care historically opposed by the hospital sector. The policies would require Medicare to pay the same rate for services regardless of where the care is provided, an issue lawmakers and regulators have eyed for years.

House Speaker Mike Johnson (R-La.) told reporters Wednesday after a meeting with his conference that he will bring bills to the floor next week, suggesting they would be focused on the healthcare system overall.

“You’re going to see a package come together that will be on the floor next week that will actually reduce premiums for 100% of Americans who are on health insurance, not just the 7%. Remember, the COVID-era subsidy only covers 7% of Americans,” Johnson said, referring to the estimated percentage of the U.S. population affected by expiring subsidies.

Leaders made no promises about extending the subsidies, though a growing number of their members in swing districts are clamoring for some sort of extension, generally paired with new fraud restrictions.

“We’ve got to bring items right now that we have a consensus on because we have such a small majority,” House Majority Leader Steve Scalise (R-La.) told reporters, adding that there wasn’t consensus on subsidies.

GOP proponents of an extension acknowledged they don’t have full support yet, but insisted there was still a chance.

“If the goal is unanimity, I don’t think you’re going to achieve unanimity within either either conference on this issue,” said Rep. Kevin Kiley (R-Calif.), who has floated a plan of his own. “What we need is a compromise that gets majority support.”

The range of ideas that could emerge on the floor appeared wide. In addition to the site-neutral payment legislation, representatives also discussed creating new risk pools outside of the ACA’s rules, cracking down on fraud and funding cost-sharing reductions for the marketplace Silver plans.

Many members who attended the meeting said they supported the idea of expanding health savings accounts as a way to fund insurance purchases, as a Senate bill that will get a vote Thursday proposes.

“It’s a game of elimination,” said Rep. Ralph Norman (R-S.C.). “It’s game of putting [bills] on the floor. We’re doing this hurriedly.”

Most Republicans seem intent on ensuring tighter abortion restrictions need to be included in any bill that involves the ACA, even if some acknowledge such provisions will cause Democrats to block any compromises in the Senate, where 60 votes are needed.

“The real problem is the Hyde Amendment issue, and I would urge that our groups that support us look at the big picture here,” said Rep. Dr. Greg Murphy (R-N.C.), referring to the restrictions. “We either have incremental wins or we lose everything.”

Democrats in the Senate panned several of the GOP offerings on the table in their chamber. The Senate Republican proposal includes elements under discussion in the House, such as health savings accounts, cost-sharing reductions, and new restrictions on enrollees.

“The insurance offerings in the Republican bill are snake oil,” said Senate Finance Committee ranking member Ron Wyden (D-Ore.). “They will spark a new avalanche of junk insurance plans, where insurance companies make out like bandits. The Republican plan is going to leave millions of people, in my view, racked with poverty.”

Sen. Amy Klobuchar (D-Minn.) highlighted Democrats’ opposition to new abortion restrictions.

“I don’t understand, when we’ve had a number of Republicans in the House and the Senate say they get it, this is a disaster to have these premiums double and triple, why they want to mess around right now and put abortion politics into the middle of this [when] they know that’s not going to work,” she said.

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