After the Senate failed this week to advance competing health care plans, attention has shifted to the House, where Republicans are making a last-minute push as the clock runs out to prevent higher insurance costs for millions of Americans.
Speaker Mike Johnson unveiled a sweeping Republican proposal late Friday, moving ahead without extending enhanced tax subsidies that help people afford insurance through the Affordable Care Act, also known as Obamacare. Those subsidies, expanded during the COVID-19 pandemic, are set to expire at the end of the year.
Why It Matters
President Donald Trump has said he believes Republicans can deliver a better alternative to Obamacare, a promise he has made repeatedly over the years. But he has offered few specifics beyond proposing direct payments to help Americans buy insurance.
What To Know
Johnson, a Louisiana Republican, spent much of Friday behind closed doors with GOP lawmakers, as he had earlier in the week, working to assemble the package as the House enters the final days of its 2025 legislative session. The Speaker said in a statement announcing the Lower Health Care Premiums for All Americans Act that the House plans to vote on the package next week.
Democrats staged the longest federal government shutdown in U.S. history this fall in a failed attempt to force Republicans to negotiate over health care. Despite promises of votes, the Senate this week failed to advance both a Republican-backed health plan and a Democratic bill that would have extended the enhanced ACA tax credits for three years.
With just days remaining before lawmakers leave Washington, Congress appears poised to adjourn without a consensus solution.
House Republicans released a package of more than 100 pages that centers on long-standing GOP priorities aimed at reshaping the health insurance market. The plan seeks to expand access to employer-sponsored coverage and increase oversight of pharmacy benefit managers, or PBMs, while leaving the enhanced ACA subsidies to expire.
A central element of the proposal would expand access to so-called association health plans, allowing small businesses and self-employed individuals to band together to purchase insurance. Supporters argue that pooling coverage gives employers greater bargaining power to negotiate lower premiums.
Critics, however, warn that association plans often provide fewer benefits and weaker consumer protections than plans sold through the ACA marketplaces.
The proposal also would require PBMs to provide more detailed data, a move Republicans say could help rein in prescription drug costs. PBMs act as intermediaries between drugmakers, insurers and pharmacies, and critics across party lines have accused them of inflating prices and squeezing independent pharmacists.
The GOP package also references cost-sharing reductions for some lower-income ACA enrollees, but those changes would not take effect until January 2027.
Notably absent from the plan is any extension of the enhanced ACA tax credits that millions of Americans rely on to lower their monthly premiums. Those subsidies, enacted during the pandemic, expire Dec. 31. Without congressional action, many families could see their out-of-pocket premiums more than double, and in some cases increase by far more.
Trump has consistently promoted the idea of sending money directly to individuals rather than extending ACA tax credits. It remains unclear how large such payments would be. A Senate Republican plan that failed this week would have created new health savings accounts funded with $1,000 annually for most adults, or $1,500 for people ages 50 to 64.
No such health savings accounts appear in the House plan.
Johnson’s approach has put politically vulnerable House Republicans in swing districts under mounting pressure as the subsidy deadline nears.
Frustrated with delays, a group of centrist Republicans has joined Democrats to push alternative proposals to temporarily extend the ACA tax credits to avoid immediate premium hikes.
Those lawmakers are backing several bills and have begun signing discharge petitions, a rarely successful procedural tactic that can force a vote on legislation if a majority of House members sign on.
This year, however, discharge petitions have gained unusual traction. Lawmakers recently used one to force a vote on releasing Jeffrey Epstein-related files held by the Justice Department.
One petition, sponsored by Rep. Brian Fitzpatrick, R-Pa., had attracted 24 signatures as of Friday, evenly split between Republicans and Democrats. It would compel a vote on a bill extending the subsidies for two years while adding anti-fraud provisions and PBM restrictions.
Another petition, introduced by Rep. Josh Gottheimer, D-N.J., has drawn 39 bipartisan signatures and would force a vote on a one-year subsidy extension with new income caps.
Both efforts could succeed if House Democratic leader Hakeem Jeffries urges his caucus to sign on. So far, he has declined to commit.
Jeffries is also backing a separate Democratic petition with 214 signatures that would extend the subsidies for three years without changes. No Republicans have joined that effort, and Senate Republicans have made clear such a proposal has no chance of passing their chamber.
What People Are Saying
Johnson said in a statement, in part, “Nearly 15 years ago, the Democrats’ Unaffordable Care Act broke the American health care system. Since its inception, premium costs have skyrocketed, networks have shrunk, and the system has become bloated, inefficient, and riddled with waste, fraud, and abuse. 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.”
Trump said late Friday at a White House event, “I want to see the billions of dollars go to people, not to the insurance companies. And I want to see the people go out and buy themselves great healthcare.”
Jeffries said Friday, “We’re actively reviewing those two discharge petitions and we’ll have more to say about it early next week.”
What Happens Next
As Congress nears adjournment, the fate of millions of Americans’ health care costs remains uncertain.
Updates: 12/12/2025, 7 p.m. ET: This article was updated with new information and remarks.
Updates: 12/12/2025, 7:43 p.m. ET: This article was updated with new remarks.
This article includes reporting by the Associated Press.