House Speaker Johnson rebuffs efforts to extend health care subsidies,
pushing ahead with GOP plan
[December 17, 2025]
By KEVIN FREKING and LISA MASCARO
WASHINGTON (AP) — House Republican leaders are determined to push ahead
with a GOP health care bill that excludes efforts to address the soaring
monthly premiums millions of Americans will soon endure as pandemic-era
tax credits for people who buy insurance through the Affordable Care Act
expire at year's end.
Speaker Mike Johnson had discussed the prospect of allowing more
politically vulnerable GOP lawmakers a chance to vote on their amendment
that would temporarily extend pandemic-era subsidies for ACA coverage.
But after days of private talks, leadership sided with the more
conservative wing of the conference, which has assailed the subsidies as
propping up a failed ACA marketplace.
“We looked for a way to try to allow for that pressure release valve,”
Johnson said Tuesday at the Capitol. “In the end, it was not — an
agreement wasn’t made.”
The maneuvering surrounding the health care vote all but guarantees that
many Americans will see substantially higher insurance costs in 2026. In
the Senate, a bipartisan group was still trying to come up with a
compromise to extend the subsidies, which fueled this year's government
shutdown. But senators made clear that any potential legislation would
likely wait until January, after the holiday break.
Instead, House Republicans will pursue their 100-plus-page health care
package that focuses on long-sought GOP proposals designed to expand
insurance coverage options for small businesses and the self-employed. A
test vote is expected Wednesday.
The Republicans' package would clamp down on middlemen called pharmacy
benefit managers who work to manage drug costs and process claims for
insurance plans. The bill would also expand access to what’s referred to
as association health plans, which would allow more small businesses and
self-employed individuals to band together and purchase health coverage.
An analysis from the nonpartisan Congressional Budget Office and the
Joint Committee on Taxation estimates the package would decrease the
number of people with health insurance by an average of 100,000 per year
over a 2027-2035 window, while reducing the federal deficit by $35.6
billion.
Failing to address expiring insurance subsidies ‘political
malpractice’
Rep. Mike Lawler, R-N.Y., blasted the leadership’s decision to not allow
for a vote to temporarily extend the health insurance subsidies, saying
it amounted to “political malpractice.”
Lawler, who hails from a competitive district, noted that most people
who get their health coverage through the Affordable Care Act live in
states that President Donald Trump won and said the changes proposed for
a temporary extension were “conservative reforms.” He also criticized
Democratic leader Hakeem Jeffries for not pushing Democrats to support a
pair of bipartisan extension efforts.
“You have two leaders who are not serious about solving this problem,”
Lawler said of Johnson and Jeffries.
Still, the centrist Republicans indicated they would not try to block
the Republican leadership’s measure from coming to a vote.
Johnson defended the House GOP's bill, which includes priorities that
Republicans have been working on for several years.
“We have a long list of things that we know will reduce premiums,
increase access and quality of care,” Johnson said. “The Democrats have
zero ideas, zero concepts and zero legislative plans on anything they’ll
propose other than just subsidizing the broken system.”
Democrats said even if the bill passes the House, it will not pass the
Senate, where it would need 60 votes and bipartisan support to advance.
They said it was not a serious effort to address rising costs.
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Speaker of the House Mike Johnson, R-La., meets with reporters as
Republicans struggle with a plan to address growing health care
costs, at the Capitol in Washington, Tuesday, Dec. 16, 2025. (AP
Photo/J. Scott Applewhite)
"Millions will be priced out of their coverage, and those who can
still afford it will get less while paying more," said Rep. Suzan
DelBene, chair of the House Democratic campaign arm. “Republicans
are ignoring the pain, the pain we’re seeing across the country for
everyday Americans. And make no mistake, it is going to cost them
the majority.”
GOP bill focuses on insurance options and cost-sharing
During Trump's first term, his administration sought to expand
access to association health plans that don't have to offer the full
menu of benefits required under current law. The option offers lower
premiums for small businesses and self-employed people, but the
policies are likely to cover fewer benefits. A federal judge who
struck down the administration's effort in 2018 said the plans were
were “clearly an end-run” around consumer protections required by
the Affordable Care Act, also known as Obamacare.
The House Republican plan would also restore government funding for
cost-sharing reductions, or CSRs, a type of financial help that
insurers give to low-income ACA enrollees on silver-level plans that
reduces their share of costs like deductibles and copays.
From 2014 until 2017, the federal government reimbursed insurance
companies for CSRs — but in 2017, the Trump administration stopped
making those payments. To make up for the lost funds, insurance
companies hiked premiums for silver-level plans -- a complicated
move that ended up increasing the financial assistance many
enrollees get to help pay for premiums.
As a result, health analysts say that while restoring funding for
CSRs would likely bring down silver-level premiums, it could also
have the unwelcome ripple effect of increasing many people’s net
premiums on bronze and gold plans.
The provisions related to pharmacy benefit managers require the
middlemen to disclose certain data about their operations to group
health plans, with the hope that more transparency would reduce
prescription drug costs.
Senators revive talks of action in the new year
Almost two dozen Republicans and Democrats met late Monday to talk
about a last-minute fix on the ACA tax credits after the Senate
rejected two partisan health care bills last week. 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 some
version of a GOP proposal to create new health savings accounts that
would help people purchase insurance.
Maine Sen. Susan Collins, a Republican who led the bipartisan
meeting, said the group would like to announce a proposal this week.
But there were still significant unresolved issues, including
whether to include stricter language on abortion funding.
Disagreements over abortion were one of the main sticking points in
earlier talks that derailed a compromise.
Senate Majority Leader John Thune said there's a “potential pathway”
to an agreement in January, but acknowledged, “we’re not going to
pass anything by the end of this week."
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Staff writers Mary Clare Jalonick and Ali Swenson contributed to
this report.
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