House GOP passes 'first step' health care bill, considers broader package in 2026

House Republicans passed a health care bill on Wednesday that could serve as a catalyst for a broader measure next year to expand choices beyond Obamacare and lower costs for all Americans.

The bill included proposals that had GOP consensus, including provisions to give consumers more options when shopping for health insurance and price transparency on prescription drug costs.

It passed 216-211, with all Democrats and Kentucky GOP Rep. Thomas Massie in opposition.

House Speaker Mike Johnson, Louisiana Republican, and other GOP leaders have said their goal is to build support for more expansive proposals they can pass in the first quarter of 2026, likely through a party-line budget reconciliation package.

“We have a long list of things that we know will reduce premiums, increase access and quality of care,” Mr. Johnson said. “We’re the only party that’s going to be bringing that forward. The Democrats have zero ideas … other than subsidizing a broken system.”

The bill the House passed Wednesday is a “good first step” to fixing Obamacare, said Rep. August Pfluger, Texas Republican.

“We should do more as a Republican Conference, including creating Trump Health Freedom Accounts and allowing Americans to shop across state lines, encouraging competition,” he said.

Those ideas are among the many on the table for consideration in a 2026 health care package.

The year-end health care debate in Congress has been spurred by the pending Dec. 31 expiration of Democrats’ COVID-era expansion of Affordable Care Act premium tax credits.

Most Republicans oppose extending the extra Obamacare subsidies, arguing it would throw good money at a bad system and just mask the rising costs of premiums.

But they are under pressure to come up with alternatives as Democrats blame them for inaction that will lead to massive out-of-pocket premium spikes for the 22 million Americans who benefit from the enhanced subsidies.

“What are you doing? Why won’t you use your immense power as the majority to help the American people?” Democratic Whip Katherine Clark of Massachusetts asked Republicans during floor debate on their bill.

Republicans said they are trying to help all Americans, not just the 7% on Obamacare, and their bill would do that.

“Unlike Democrats, we're not attempting to place a Band-Aid on a ruptured artery and call it a day,” said Rep. Virginia Foxx, North Carolina Republican. “Republicans are offering a clear, responsible and straightforward solution so that all Americans have access to health care that is affordable and meets their respective needs.”

The GOP bill includes proposals to expand consumer choices for purchasing health insurance, including a provision to allow smaller employers and the self-employed to band together to form association health care plans to negotiate with insurers for lower rates.

The bill would also codify and strengthen 2019 Trump administration rules allowing employers to offer employees the option to purchase their own health insurance with pre-tax dollars instead of an employer-sponsored plan.

Another provision makes it easier for employers to offer self-insured group health plans, instead of going through insurance companies.

The bill would also, starting in 2027, fund Obamacare’s cost-sharing reductions that help lower deductibles for lower-income families who purchase silver-level Obamacare plans. Insurers are required to offer the reductions but the government hasn’t paid for them since 2017, so insurers have inflated premiums for silver plans to make up for the cost.

Republicans argue that funding cost-sharing reductions will reverse the “silver loading” and stabilize the individual market.

Democrats said GOP language preventing the funding from subsidizing plans that include abortion coverage will unfairly penalize blue states that have laws requiring such coverage.

The bill also includes a provision to require pharmacy benefit managers, the intermediaries between drug companies and pharmacies that lawmakers blame for driving up prices, to provide cost transparency data.

The Congressional Budget Office estimates the collective package would save taxpayers nearly $36 billion over the next 10 years. The bill would also reduce gross premiums by 11%, on average, through 2035 but cause roughly 100,000 people to drop health insurance coverage, CBO said.

Democrats spent most of their debate time pushing for an extension of the enhanced Obamacare subsidies and slamming the GOP bill as an effort to promote “junk insurance” plans that do not cover preexisting conditions or other essential health benefits.

“This bill that they want to replace [Obamacare] with is a bamboozle, it’s a hoodwink, it’s a scam for the American people,” said Rep. Raul Ruiz, California Democrat.

Republicans tried and failed in 2017 to repeal and replace the Affordable Care Act.

Republicans still believe Obamacare failed to deliver on its promises to lower health care costs, but Mr. Johnson said it is “too deeply ingrained” in the American health care system to repeal.

“So now we have to take it step by step to reduce costs and repair the system,” he said.

The question is whether Republicans can unite around their next steps, especially with swing-district members angry that GOP leaders shot down their bipartisan proposals to temporarily extend the enhanced Obamacare subsidies as a bridge to a larger health care overhaul.

Rep. Kevin Kiley, California Republican, said he voted for Wednesday’s bill because it contained good policies but “it’s extremely modest and it has no chance of becoming law.” He believes any health care overhaul should be bipartisan.

“This whole issue encapsulates what is wrong with this institution,” Mr. Kiley said. “Party leaders focus most of their time and energy on trying to blame problems on the other side rather than trying to solve those problems.”