House sets up health bill vote to end enhanced ACA subsidies

Modern Healthcare – Monday, December 15, 2025
By Michael McAuliff

House Republican leaders are preparing a vote this week on a healthcare bill that lets enhanced premiums for marketplace insurance plans expire, all but guaranteeing their end.

Instead, the bill aims to promote association health plans, improve transparency among pharmacy benefit managers and fund cost-sharing reductions in Affordable Care Act plans that lower benchmark premiums but raise enrollees’ cost. It also includes abortion restrictions.

While the bill, cobbled together by House Majority Leader Steve Scalise (R-La.), doesn’t have any extensions for current subsidies, proponents of an extension may get a chance to vote on an amendment, which is expected to be decided at House Rules Committee meeting Tuesday. A floor vote would likely follow on Wednesday.

Most Republicans oppose extending the more generous subsidies that were added by Democrats during the COVID-19 pandemic to the Affordable Care Act of 2010.

Those subsidies expire at the end of the month, leaving enrollees facing average premium hikes of 114%, according to estimates from health research organization KFF. Middle-income earners face much higher increases. Open enrollment runs until Jan. 15, but enrollment for plans that begin Jan. 1 ends Monday.

The new Republican bill was unveiled Friday night, and bares almost no resemblance to a proposal offered by Republicans in the Senate that focused on health savings accounts. That measure failed in votes Thursday alongside a Democratic bill to extend current subsidies for three years.

The House GOP bill centers on the party’s long-held goal of expanding association health plans so more small employers and self-employed people could band together to buy insurance.

While such plans would have ACA protections for people with pre-existing conditions, association plans don’t have to meet all the standards of the Affordable Care Act. That could make them cheaper, attracting healthier enrollees who may not be as worried about less comprehensive coverage.

Democrats and many experts call them junk insurance, and warn they will draw healthier people out of the marketplace, leaving behind a sicker population and driving up premiums for fuller coverage. Courts blocked President Donald Trump’s attempt to create them by regulation in his first administration.

A second part of the GOP House plan is to fund cost-sharing reductions, which Trump halted in his first term as an attempt to undermine the Affordable Care Act. The cost-sharing payments were meant to go to insurers to prevent those expenses from being passed on the enrollees.

Insurers responded by hiking the costs of the benchmark silver plans — known as “silver loading” — which had the effect of raising silver plan premiums and increasing the subsidies the government provided to buy those plans and others. Funding cost-sharing reductions would cause silver plan premiums to fall, but the government would also cut subsidies. The Congressional Budget Office estimated a similar proposal Republicans made over the summer would cause some 300,000 to drop insurance by 2034.

The third key part of the bill is to dramatically raise transparency and reporting requirements for pharmacy benefit managers. Such measures are widely popular, but in this case lack other PBM provisions that have emerged over the last two years to change how drug industry middlemen earn compensation.

Lastly, the bill would bar any cost-sharing payments from going to insurance plans that cover abortion — a measure that Democrats regard as a de facto abortion ban and a nonstarter guaranteeing they will not support it. Even if it passed on a partyline vote, it could not pass the Senate.

There still remains a narrow path for a subsidy extension. Republicans from swing districts have advanced bills with two-year extensions through what are known as discharge petitions. In those cases, the bills must attract 218 supporters in order to get a floor vote, usually on the second or fourth Monday of the month, which likely would be after the enhanced premiums expire. They would require nearly all Democrats to back them, as well, and Democratic leaders have so far declined to endorse them.

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