Speaker Johnson scrambles to find a health care plan as Republicans remain divided

WASHINGTON (AP) — The Senate failed to get anywhere on the health care issue this week. Now it’s the House’s turn to show what it can do.

Speaker Mike Johnson is in a last-minute sprint to develop a Republican alternative, as his party refuses to extend tax subsidies for those who buy policies through the Affordable Care Act, also called Obamacare, which are expiring at the end of the year. Those subsidies help lower the cost of coverage.

Johnson, R-La., huddled behind closed doors Friday morning — as he did days earlier this week — working to assemble a package for consideration as the House focuses the final days of its 2025 work on health care.

“We’re making final decisions,” said Majority Leader Steve Scalise, R-La. “We have a couple more conversations to have, but we’re getting close.”

Time is running out for Congress to act. Democrats engineered the longest federal government shutdown ever this fall in a failed effort to force Republicans to the negotiating table on health care. But after promising votes, the Senate failed this week to advance both a Republican health care plan and the Democratic-offered bill to extend the tax credits for three years.

Now, with just days to go, Congress is about to wrap up its work with no solution in sight.

President Donald Trump, speaking at a holiday party at the White House, said he believes Republicans are going to figure out a better plan than Obamacare — something he has promised for years — but he offered few details beyond his idea for providing Americans with stipends to help buy insurance.

“I really believe we can work on healthcare together and come up with something that’s going to be much better, much less expensive for the people, less expensive for our nation,” Trump said at Thursday night’s reception.

The president touted his proposal for sending money directly to Americans to help offset the costs of health care policies, rather than extending the tax credits for those buying policies through Obamacare. It’s unclear how much money Trump envisions. The Senate GOP proposal that failed to advance would have provided payments to new health savings accounts of $1,000 a year for adult enrollees, or $1,500 for those ages 50 to 64.

“We make beautiful, big payments directly to the people and they buy their own health insurance,” Trump said.

Finding consensus among rank-and-file Republicans is far from guaranteed, as the health care issue has long split the party.

What Republicans are proposing

The emerging package from the House Republicans is not expected to include an extension of an enhanced tax credit for millions of Americans who get insurance coverage through the Affordable Care Act. Put in place during the COVID-19 crisis, that enhanced subsidy expires Dec. 31, leaving most families in the program facing more than double their current out-of-pocket premiums, and in some cases, much more.

Johnson told reporters the bill Republicans are pursuing would “reduce premiums for all Americans, not just 7% of them,” a reference to the 24 million enrolled in ACA plans.

Instead, the GOP’s legislation would likely expand health savings accounts and association health plans, lawmakers said.

The latter would allow more small businesses and self-employed individuals to band together and purchase health coverage as part of an association. Proponents say such plans increase the leverage businesses have to negotiate a lower rate. But critics say the plans provide skimpier coverage than what is required under the Affordable Care Act.

Scalise said Republicans were also reviewing new restrictions for pharmacy benefit managers, or PBMs, which contract with insurers to administer their prescription drug benefits and help control costs. Critics say PBMs have enacted practices that pad their bottom line but have made it more difficult for independent pharmacists to survive.

Political pressure is building for many

Going Johnson’s route has left vulnerable House Republicans representing key battleground districts in a tough spot.

Frustrated with the delays, a group of more centrist GOP lawmakers is aligning with Democrats to push their own proposals for continuing the tax credits, for now, so that Americans don’t face rising health care costs.

They are pursuing several paths for passing a temporary ACA subsidy extension, co-sponsoring a handful of bills. They are also signing onto so-called discharge petitions that could force a floor vote if a majority of the House signs on.

Such petitions are designed to get around the majority’s control and are rarely successful, but this year has proven to be an exception. Lawmakers, for example, were able to use a discharge petition to force a vote on the release of the Jeffrey Epstein files held by the Department of Justice.

One petition, filed by Rep. Brian Fitzpatrick, R-Pa., had signatures from 12 Republicans and 12 Democrats as of Friday afternoon. It would force a vote on a bill that includes a two-year subsidy extension and contains provisions designed to combat fraud in the ACA marketplace. There are also restrictions for PBMs, among other things.

Another petition from Rep. Josh Gottheimer, D-N.J., has 39 signatures and is broadly bipartisan. It’s a simpler proposal that would force a vote on a one-year ACA enhanced subsidy extension and would include new income caps limiting who qualifies for the enhanced credit.

Both discharge petitions have enough Republicans’ support that they would likely succeed if Democratic leader Hakeem Jeffries encouraged his caucus to jump on board. So far, he’s not tipping his hand.

“We’re actively reviewing those two discharge petitions and we’ll have more to say about it early next week,” Jeffries said.

Meanwhile, Jeffries is pushing Democrats’ own discharge petition, which has 214 signatures and would provide for a clean three-year subsidy extension. No Republicans have signed onto that one.

And as Republicans made clear in the Senate this week, a three-year extension without changes to the program has no chance of passing their chamber.