House Republicans finalized a bill on Friday that Speaker Mike Johnson said will provide “clear, responsible alternatives” to Obamacare.
The measure is designed to show that the GOP has an answer to the health care affordability issue as Democrats hammer them over their opposition to extending enhanced Obamacare premium subsidies expiring Dec. 31.
“While Democrats demand that taxpayers write bigger checks to insurance companies to hide the cost of their failed law, House Republicans are tackling the real drivers of health care costs to provide affordable care, increase access and choice, and restore integrity to our nation’s health care system for all Americans,” Mr. Johnson said in a statement.
He said the House will vote on the GOP bill before leaving for a Christmas break on Dec. 18.
House Minority Leader Hakeem Jeffries told reporters Friday ahead of the bill’s release that, based on proposals Republicans had publicly floated, he expected it “to be a disaster and actually not enhance the health care of the American people.”
The GOP bill is called the Lower Health Care Premiums for All Americans Act because Republicans say that’s who it is designed to help, not just the roughly 7% of Americans on Obamacare.
The measure includes proposals to expand consumers’ choices for purchasing health insurance that Republicans say will drive competition up and prices down.
One is a provision to allow groups of employers to form association health plans so they can negotiate with insurers for lower rates.
However, the bill stipulates some limits, including that the association has to have been formed for purposes other than providing health insurance and existed for at least two years before offering a group health plan.
The bill would also codify and strengthen 2019 Trump administration rules to give employees an alternative to their employer-sponsored coverage.
The so-called CHOICE arrangements would allow employers to offer defined contributions for employees to purchase their own health insurance. Employees would still be able to pay for their premiums with pre-tax dollars, like they would for employer-sponsored plans.
The measure also includes a provision to help small businesses that offer employees more tailored and affordable health plans to protect themselves from catastrophic claims.
One part of the bill deals with Obamacare by funding cost-sharing reduction, or CSR, payments beginning in 2027.
CSRs were enacted as part of the Affordable Care Act to lower deductibles for families earning 100% to 250% of the poverty level who purchase silver-level Obamacare plans but haven’t been funded in years.
A federal judge ruled in 2016 that the government could not fund direct CSR payments without an explicit congressional appropriation. The ruling was stayed upon appeal, but the Trump administration chose to end the CSR payments in 2017 as Republicans worked on their failed effort to repeal and replace Obamacare.
To compensate for the loss of the CSR payments, insurers inflated premium prices for silver plans. Republicans argue that funding CSRs will reverse the “silver loading,” lower premium costs and stabilize the individual market.
House Republicans passed CSR funding earlier this year as part of the One Big Beautiful Bill Act. It was stripped in the Senate after Democrats flagged it as out of compliance with the budget reconciliation rules.
House Republicans opted against including a bipartisan bill to crack down on pharmacy benefit managers, the intermediaries between drug companies and pharmacies that lawmakers blame for driving up prices, that was stripped from a year-end spending package last year.
But they did include a part of that measure that requires pharmacy benefit managers to provide employers with detailed data on prescription drug spending, rebates and spread pricing to provide cost transparency.
Republican leaders met Friday morning with representatives of different ideological factions in their conference to hammer out the final details of the legislation.
They also discussed potentially giving more moderate Republicans who want to temporarily extend the enhanced Obamacare premium subsidies an amendment vote as part of the package.
The details of that would be finalized when the House Rules Committee meets on Tuesday to decide what amendments to allow on the floor.
