House Republicans set to vote on 'responsible alternative' to Obamacare

The House will vote this week on a Republican health care package that Speaker Mike Johnson said will provide “clear, responsible alternatives” to Obamacare.

The measure is designed to show that Republicans have an answer to the issue of affordable health care as Democrats hammer them over their opposition to extending enhanced Obamacare premium subsidies expiring Dec. 31.

“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,” Mr. Johnson, Louisiana Republican, said in a statement.

The House is scheduled to vote on the Republican bill before leaving Friday for its Christmas break. The measure is unlikely to become law because it lacks Democratic support and would likely face a filibuster in the Senate.

House Minority Leader Hakeem Jeffries, New York Democrat, dismissed the Republican health care package as “toxic” and “unserious,” especially coming “just five legislative days until premiums skyrocket by as much as $1,000 or $2,000 per month for working-class Americans.”

“The bill will cause millions of people to lose coverage, promotes junk health insurance plans and further limits the freedom of women to make their own reproductive health care decisions,” he said.

The Republican bill is called the Lower Health Care Premiums for All Americans Act. Republicans say it is designed to help all Americans, not just the roughly 7% on Obamacare.

The measure includes proposals to expand consumer choices for purchasing health insurance that Republicans say will drive up competition and lower prices.

One provision allows groups of employers to form association health care plans, enabling them to negotiate with insurers for lower rates.

However, the bill stipulates some limits, including that the association must have been formed for purposes other than providing health insurance and have existed for at least two years before offering a group health care plan.

The bill would also codify and strengthen 2019 Trump administration rules, giving workers alternatives to their employer-sponsored coverage.

The arrangements would enable employers to offer defined contributions that allow employees to purchase their own health insurance. Employees would still be able to pay for their premiums with pretax dollars, just as they do for employer-sponsored plans.

Another provision would help small businesses that offer employees more tailored and affordable health care plans, thereby protecting themselves from catastrophic claims.

Rep. Frank Pallone of New Jersey and Richard Neal of Massachusetts, the top Democrats on the House Energy and Commerce and Ways and Means committees with jurisdiction over health care policy, described the Republican bill as “a handful of decades-old proposals” that will force Americans to pay more to get less.

Republican proposals would undermine coverage protections the Affordable Care Act guarantees, Mr. Pallone said.

He and Mr. Neal pointed to the House Democrats’ bill for a clean three-year extension of the enhanced Obamacare premium tax credits as “the best way to reduce health care costs for millions of Americans right now.”

“Anything less is a waste of time,” Mr. Neal said.

The Republican bill does not extend the Democrats’ pandemic expansion of the premium tax credits, but it addresses another Obamacare subsidy by funding cost-sharing reduction payments starting in 2027.

However, it stipulates that the money cannot be used to subsidize plans that include abortion coverage.

Cost-sharing reductions were enacted as part of the Affordable Care Act to lower deductibles for families earning 100% to 250% of the poverty level who purchase silver-level Obamacare plans, but they haven’t been funded in years.

A federal judge ruled in 2016 that the government could not fund direct cost-sharing reduction payments without an explicit appropriation from Congress. The ruling was stayed upon appeal, but the Trump administration ended the cost-sharing reduction payments in 2017 as Republicans worked on their failed effort to repeal and replace Obamacare.

Insurers still must offer cost-sharing reductions under the law, so they inflated premium prices for silver plans to compensate for the loss of government payments.

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

House Republicans passed cost-sharing reduction funding earlier this year as part of the One Big Beautiful Bill Act. The provision was stripped in the Senate after Democrats flagged it as out of compliance with the budget reconciliation rules.

House Republicans opted against including a bipartisan bill to crack down on pharmacy benefit managers, the intermediaries between drug companies and pharmacies that lawmakers blame for driving up prices, that was stripped from a year-end spending package last year.

They did include a part of that measure that requires pharmacy benefit managers to provide employers with detailed data on prescription drug spending and rebates and spread pricing to provide cost transparency.

Republican leaders met Friday morning with representatives of various ideological factions in their conference to finalize the details of the legislation.

They also discussed giving more moderate Republicans who want to temporarily extend the enhanced Obamacare premium subsidies an amendment vote as part of the package.

The details would be finalized when the House Rules Committee meets Tuesday to decide which amendments to allow on the floor.

Rep. Michael Lawler, New York Republican, said on Fox News that a temporary extension of the enhanced Obamacare premium tax credits is needed to provide a bridge to a longer-term overhaul of the broken health care system.

“We need to have a vote this week in the House, and that’s what we’re fighting for, and why we’ve signed on to two different discharge petitions, and why we’re negotiating with House Republican leadership to allow for a vote,” he said.

The two discharge petitions are on separate bipartisan plans with similar intents, Mr. Lawler said. Both extend the enhanced subsidies for a short time, accompanied by “serious reforms,” including income limits, minimum premium payments, cost transparency provisions and expansions of health savings accounts.