After the Senate failed to advance rival plans to address expiring enhanced Affordable Care Act subsidies, House Republicans released their own proposal that does not extend the tax credits, instead emphasizing small-business insurance pooling, new rules for pharmacy benefit managers and future cost-sharing aid for low-income enrollees — drawing swift partisan criticism as year-end premium hikes loom.
Following the U.S. Senate's failure this week to pass either a Democratic or Republican plan to deal with the looming expiration of enhanced Affordable Care Act (ACA) subsidies, House Republicans have put forward their own health care package.
The House proposal, unveiled late Friday, Dec. 12, 2025, does not renew the enhanced subsidies that are set to lapse at the end of the year, according to NPR and other outlets. Instead, it aims to tackle costs through several structural changes to the insurance market.
According to NPR's reporting, the legislation would expand ways for small businesses and some other groups to band together to buy coverage, and it would impose new transparency requirements and other limits on pharmacy benefit managers, which Republicans argue will help lower prescription drug costs. A separate provision would restart cost-sharing reduction payments beginning in 2027, with the goal of reducing premiums and out-of-pocket costs for lower-income Americans who buy coverage on the ACA marketplaces. Health plans that include abortion coverage would be excluded from certain benefits under the bill.
House Speaker Mike Johnson, R-La., said in a statement that "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," NPR reports.
Democratic House Minority Leader Hakeem Jeffries sharply criticized the package in a post on X, writing: "Mike Johnson just released a toxic Republican Healthcare plan that hurts everyday Americans. It fails to extend the ACA tax credits that expire this month. And is a deeply unserious proposal."
Johnson has said a vote on the package is expected next week, before the House departs for its December recess, according to NPR's account. The House Rules Committee is expected to determine whether amendments — including a possible push from some Republicans to extend the enhanced tax credits — can be debated when the bill reaches the floor, Reuters has reported.
The Senate earlier this week rejected a Democratic proposal to extend the enhanced ACA subsidies for three years, as well as a competing Republican measure that would have provided different assistance for health costs without extending the subsidies. Both failed to clear the chamber's 60-vote threshold, leaving millions of ACA enrollees facing higher premiums when the enhanced tax credits expire on Dec. 31, 2025.
As the deadline approaches, strategists in both parties are watching the political fallout. Polls have shown growing public support for the ACA and for maintaining the enhanced subsidies, and some Republicans — particularly those in competitive districts — have signaled interest in some form of temporary relief even as party leaders press ahead with the new House package.
Midterm elections in 2026 are still nearly a year away, but the unresolved fight over ACA subsidies and rising premiums is expected to remain a central point of partisan conflict on health care.
