Health Care Subsidies: What's Next for Americans?

House Republicans are moving forward with a health care plan that skips extending pandemic-era subsidies for Affordable Care Act (ACA) coverage. These subsidies, which helped many Americans afford health insurance, are set to expire at the end of the year. Speaker Mike Johnson had considered letting some Republicans vote on an amendment to extend these subsidies temporarily. However, after private discussions, the leadership chose to align with the more conservative members of the party. These members argue that the subsidies only support a failing ACA marketplace. This decision means that many Americans will likely face higher insurance costs in 2026. In the Senate, a bipartisan group is still working on a compromise to extend the subsidies, but any potential legislation is expected to wait until January, after the holiday break. Meanwhile, House Republicans are pushing their own health care package. This package focuses on expanding insurance coverage options for small businesses and the self-employed. It also aims to regulate pharmacy benefit managers and expand access to association health plans. An analysis by the Congressional Budget Office and the Joint Committee on Taxation estimates that the Republican package would reduce the number of insured Americans by about 100, 000 per year from 2027 to 2035. It would also cut the federal deficit by $35. 6 billion. Rep. Mike Lawler, a Republican from New York, criticized the leadership's decision, calling it "political malpractice. " He argued that the changes proposed for a temporary extension were "conservative reforms. " Despite his criticism, centrist Republicans indicated they would not block the leadership's measure.Johnson defended the House GOP's bill, highlighting priorities that Republicans have been working on for years. He claimed that the bill would reduce premiums, increase access to care, and improve quality. Democrats, however, argued that the bill is not a serious effort to address rising costs. They said that even if the bill passes the House, it will not pass the Senate, where it would need 60 votes and bipartisan support to advance. The House Republican plan would also restore government funding for cost-sharing reductions (CSRs), a type of financial help that insurers give to low-income ACA enrollees on silver-level plans. From 2014 until 2017, the federal government reimbursed insurance companies for CSRs. However, in 2017, the Trump administration stopped making those payments. To make up for the lost funds, insurance companies increased premiums for silver-level plans. Restoring funding for CSRs would likely bring down silver-level premiums, but it could also increase net premiums for bronze and gold plans. In the Senate, almost two dozen Republicans and Democrats met late Monday to discuss a last-minute fix on the ACA tax credits. They emerged from the meeting discussing ways to end the stalemate, including a possible two-year extension of the subsidies with reforms that would narrow who could receive them. They also discussed adding a GOP proposal to create new health savings accounts that would help people purchase insurance. Senate Majority Leader John Thune said there’s a “potential pathway” to an agreement in January, but acknowledged that nothing will pass by the end of this week.