Miller-Meeks and House Republican leadership unveiled the plan earlier this week shortly before some moderate Republicans bucked Speaker Mike Johnson and signed onto a Democrat-led petition to force a vote on extending enhanced Affordable Care Act (ACA) subsidies for three years.
The Republican-led bill does not include an extension of the enhanced premium tax credits. Those subsidies will expire at the end of the year, and as a result, the average premium price for ACA marketplace enrollees is expected to double in the new year.
But Republicans, who have strongly opposed extending the subsidies, say their plan addresses root issues that are not addressed by the ACA— things that they say have allowed for “waste, fraud and abuse.”
“Extending tax credits doesn’t do anything to lower health care costs or lower health care premiums. It just hides the fact that premiums are going up, but it doesn’t actually work to lower premiums,” Miller-Meeks said during a call with reporters. “We want to work to lower premiums, and that’s the genesis of this bill.”
The legislation, now headed to the Senate, includes provisions aimed at lowering costs through competition and transparency:
- Appropriations for Cost Sharing Reduction payments starting in 2027
- Reduced regulations on stop-loss coverage to lower costs for small businesses
- Expanded access to Association Health Plans that allow small businesses and self-employed workers to purchase insurance together
- Renamed and strengthened Individual Coverage Health Reimbursement Arrangements (now dubbed CHOICE arrangements) that allow employers to give employees money to purchase their own health plan
- Transparency requirements on pharmacy benefit managers to provide employers and insurers with detailed data on prescription drug pricing
According to Miller-Meeks and House GOP leadership, these provisions will fix a broken health care system.
“We want to lower health care costs for everyone, not just a select few, and not to have money continue to go to insurance companies who have no incentive to lower premiums because they’re getting a direct subsidy from the federal government,” Miller-Meeks said.
The COVID-era enhanced premium tax credits that Democrats want to extend expanded Obamacare to people earning above 400% of the federal poverty level, including many small business owners and farmers. But the tax credits also reduced premium costs for everyone in the ACA marketplace.
During a news conference on the bill with House leadership, the speaker of the House blamed Democrats for rising premiums.
“There is a health care affordability problem in America,” Johnson said. “For 15 long years, Americans have now faced skyrocketing premiums, fewer quality choices, inefficient care and widespread waste, fraud and abuse.”
But health care policy experts say the thing that would save the most money for individual enrollees over the next few years would be an extension of the premium subsidies.
“There are people whose premiums are going up $2,000 a month in 2026. It’s an insane amount of money for people who are not particularly high income, and there’s not a lot that’s visible in this current proposal that would bring that payment down by $2,000 a month in the next year,” said Emma Wager, a senior policy analyst with the health policy think tank, KFF.
Policy expert says bill focuses on ‘systemic changes’
Wager said there is potential in the GOP health care bill for greater transparency in drug pricing to bring down the cost of prescription drugs, but it’s not clear how much or how soon that might happen. It’s just that — potential, she said.
“I think most of the provisions in this House bill are more long-term, systemic changes, and they aren’t necessarily going to impact things that are happening to people’s wallets in two weeks when the new year comes around,” Wager said.
But, she added, the Congressional Budget Office (CBO) has said the bill could reduce the deficit by $35.6 billion over 10 years. By contrast, extending the enhanced premium tax credits over 10 years would cost nearly $350 billion.
The CBO also estimated that an average of 100,000 people per year will lose health insurance between 2027 and 2035 with the passage of Miller-Meeks' bill.
“With the end of the enhanced premium tax credit, the responsibility is then shifting for a percentage of the tax credit,” Wager said. “A percentage of the premium payment is coming from the government to the individual.”
Wager said expanded access to Association Health Plans would likely increase the number of younger, healthier adults on non-ACA compliant plans, leaving more expensive enrollees in the ACA marketplace.
“The average enrollee will get older and sicker, and then every year, as the premiums go up, the healthiest people in the market will drop out,” Wager said. “And it creates a death spiral, where eventually you’re left with a pretty rapidly disintegrating risk pool.”
But Wager said the CHOICE arrangements provision that allows companies to give employees money to seek their own health plans could benefit the ACA marketplace by drawing in more young workers.
“There are some other avenues that you may be able to use, but primarily you’re given your reimbursement from your employer to go find your own health coverage, which is predominantly done in the individual market,” Wager said.
As for the impact of the Cost Sharing Reduction appropriations, Wager said subsidies in general will go down because they will be pegged to lower premium amounts.
Since Cost Sharing Reductions are only given to ACA enrollees with silver plans earning 100-200% of the poverty level, and since the amount of subsidies in the marketplace is largely based on silver plan premiums, Wager said lowering them through Cost Sharing Reductions payments means everyone’s subsidies would be smaller.
“The premium amount for a silver plan will go down, but that means that the subsidy amount will go down as well, so people will get smaller subsidies,” she said.
The CBO estimates enacting the bill would reduce gross benchmark premiums by an average of 11% through 2035.
What’s next?
Even though the House Democrat-led discharge petition to extend the ACA enhanced premium subsidies for three years received the necessary 218 signatures to force a vote, that won’t happen until January, based on Johnson's comments to the House before they broke for Christmas recess on Thursday.
If the House approves the extension, the bill will likely die in the Senate. The upper chamber rejected a nearly identical bill pushed by Senate Democrats last week and also rejected a Senate Republican-led health care proposal.
Some Senators have said they hope to vote on the House Republicans' bill in January before the next government funding deadline.
