House Republicans have now reportedly rolled out a major health care proposal Friday, setting up a vote next week on a bill aimed at lowering costs, increasing transparency, and reining in the pharmacy benefit manager (PBM) industry — all while refusing to extend Obamacare’s expiring enhanced subsidies. The decision reflects a GOP conference still deeply divided over whether the controversial subsidies should be allowed to lapse at the end of the year.
The bill, titled the “Lower Health Care Premiums for All Americans Act,” centers on provisions broadly supported across the Republican Party. According to House GOP leadership aides, the package includes policies that have already cleared key committees and are intended to strengthen the private insurance market rather than expand federal involvement.
To appease centrist Republicans who demanded a vote on subsidies, GOP leaders will allow an amendment to be offered on extending the expiring Obamacare tax credits. A leadership aide said the details are still being negotiated but confirmed that the amendment process “will allow for that amendment.” Allowing the vote provides moderates political cover while not committing the party to a policy that many conservatives reject.
The legislation appropriates funds for cost-sharing reductions in Obamacare — a complex move that would lower premiums for some consumers while reducing total subsidies and raising premiums for others. Leadership aides noted that such provisions have previously run afoul of Senate rules and could cost hundreds of thousands of people their insurance coverage according to estimates. Still, supporters argue that restructuring the subsidy formula is essential to restoring sanity to the individual market.
The bill also includes measures to help businesses self-insure without facing bankruptcy risks from catastrophic claims. It expands association health plans, long supported by Republicans as an affordable alternative to restrictive Obamacare exchanges, and introduces new transparency requirements for the PBM industry — which many lawmakers accuse of driving up drug prices through opaque pricing schemes.
However, the bill does not include an expansion of health savings accounts, a popular reform in many other GOP health proposals. Leadership says those debates will continue in the months ahead.
The real flashpoint remains Obamacare’s enhanced subsidies. Conservatives argue that extending them would cement an expensive policy they oppose philosophically and financially. Moderates warn that allowing the subsidies to expire would trigger drastic premium spikes for 22 million Americans and create a political nightmare heading into the 2026 midterms.
Because the party is so fractured — and because leadership itself opposes extending the subsidies — GOP leaders chose not to include an extension in the underlying bill. But after moderates attempted to force votes through discharge petitions, leadership agreed to an amendment vote that has little chance of becoming law.
Even if a handful of Republicans vote for the amendment, Democrats are not expected to back it, and if the amendment were somehow adopted, it would likely doom the overall health care package by driving conservatives away.
House Minority Leader Hakeem Jeffries quickly attacked the GOP plan, calling it “a disaster” and claiming it would not “enhance the health care of the American people.” Jeffries’ criticism signaled that Democrats will continue defending Obamacare subsidies rather than engaging with Republicans on broader market-based reforms.
The Republican package now heads to the floor next week, where the party must balance policy, politics, and the internal tug-of-war over how aggressively to break with Obamacare’s costly structure.
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