House Republicans are under increasing pressure to finalize a health care plan ahead of the holiday recess, aiming for a vote next week. The urgency is heightened by the impending expiration of subsidies for the Affordable Care Act (ACA) on December 31, 2023, which, if not extended, could lead to significant increases in insurance premiums for millions of Americans.
The leadership team, led by House Speaker Mike Johnson of Louisiana, is moving forward with a proposal that does not extend the ACA subsidies. Instead, it would provide funding to help Americans manage health care costs. This stance is controversial among Republicans, particularly those in competitive districts who argue for a bipartisan approach that includes extending the subsidies.
Inside a recent closed-door meeting, conservative members voiced their concerns. Representative Ralph Norman of South Carolina emphasized the need for a unified strategy, stating, “The consensus is we need to come up with something.” Another influential voice, Representative Jim Jordan of Ohio, cautioned that omitting ACA funding from the plan could lead to a coalition of moderate Republicans and Democrats pushing for a vote through a discharge petition, thereby reducing the party’s influence.
Johnson intends to hold a floor vote just before lawmakers depart for a two-week recess, despite the lack of consensus on the contents of the plan. Proposed ideas during the discussions included expanding health savings accounts and increasing funding for cost-sharing reductions. Johnson remarked, “We have some low-hanging fruit. We have some things that every Republican agrees to; Democrats won’t.”
While there is some agreement on smaller reforms, many Republicans acknowledge that a comprehensive overhaul of the ACA—a challenge the GOP has faced for nearly 15 years—will require more time and deliberation. Representative Dusty Johnson of South Dakota noted, “Health care is unbelievably complicated. You’re not going to reform and bring down costs overnight.”
Amid this complexity, a bipartisan effort is emerging. Recently, 15 House Republicans representing swing districts joined a framework proposed by Representatives Jen Kiggans of Virginia and Josh Gottheimer of New Jersey to extend ACA subsidies for two years, with modifications. This coalition, however, is outnumbered within the GOP, where many members oppose any support for what they term “Obamacare.”
Johnson has indicated a preference for aligning with the majority of his conference, which largely opposes extending the ACA funding. A GOP lawmaker mentioned that the Speaker is “drawing a line in the sand” against the extension of ACA tax credits, complicating efforts for those advocating for a bipartisan solution.
The concept of a discharge petition, which would allow a majority of the House to force a vote on the legislation, remains uncertain. A successful petition would require 218 signatures, meaning several Republicans would need to join forces with all Democrats. Representative Brian Fitzpatrick of Pennsylvania has proposed his own plan to extend ACA subsidies, which has garnered support from various Democratic representatives. Fitzpatrick is prepared to file a discharge petition if leadership does not act.
As the deadline approaches, the stakes are high for Republicans. Representative Jeff Van Drew of New Jersey stressed the necessity of extending the ACA subsidies with reforms to safeguard vulnerable GOP colleagues and maintain the party’s fragile majority. He warned that allowing the subsidies to lapse could jeopardize Republican seats in the upcoming midterms, stating, “Let’s not be self-destructive.”
Despite the urgency, any proposed measures would still face challenges in the Senate, where passage is not guaranteed. Democratic leaders have criticized the lack of action on a discharge petition, underscoring the potential for health care premiums to rise significantly if the ACA tax credits expire.
As the clock ticks down, House Republicans must navigate a complex landscape to reach an agreement that balances their party’s divisions with the urgent needs of millions of Americans facing rising health care costs.
