House Republicans plan to hold votes next week on a narrow health care bill that would allow expanded Affordable Care Act subsidies to expire as scheduled at the end of the month while making several changes aimed at holding down costs.
They released the measure late Friday afternoon, just a week before Congress was scheduled to depart for the year and as the party faced mounting political pressure to do something to address the rising premiums expected when the subsidies end.
The legislation does nothing to preserve those subsidies, though a leadership aide said that a group of Republican moderates who have been pressing for an extension would get a vote on whether to add that proposal to the bill.
But that effort faces long odds in the House, where most Republicans are deeply opposed to bolstering any portion of the Affordable Care Act. The bill they put forward instead includes a range of health care policies that congressional Republicans have been discussing for years, including a measure to allow small businesses to band together to buy insurance; new regulations on pharmacy benefit managers, the middlemen who help health plans administer prescription drug benefits; and the restoration of payments to health insurers that President Trump canceled during his first term.
Some of the changes could eventually affect the cost of health insurance, but they would be unlikely to immediately address rising health care premiums — an issue that Democrats spotlighted during the government shutdown fight and have promised to make a central focus of their midterm election efforts.
In both the House and Senate, Democrats proposed a three-year extension to the insurance subsidies. Republicans blocked the Senate proposal on Thursday.
An alternative proposed by Senate Republicans aimed to replace the subsidies with an expansion of tax-advantaged health savings accounts and direct payments of up to $1,500 to people who purchase the most basic health insurance plans. But Senate Democrats thwarted that measure as well, leaving Congress at a stalemate.
House Republicans did not include a version of either proposal in the bill that they released on Friday. But G.O.P. leaders expect to allow a floor vote on an amendment that would somehow address or extend the subsidies, according to the leadership aide, who requested anonymity to discuss ongoing plans.
The details of that amendment were not yet clear, but it may struggle to win majority support. Many Republicans oppose extending the subsidies outright, while others favor scaling them back, adding restrictions and phasing them out more rapidly. But any such changes could alienate Democrats who want a broad extension.
In a statement, Speaker Mike Johnson knocked the Democrats’ proposal as encouraging a “bloated” health care system rife with fraud.
“Republicans are offering clear, responsible alternatives that will lower premium costs and increase access and health care options for all Americans,” he said.
Many of the provisions in the new Republican bill were part of the House version of the major tax and domestic policy bill that became law this summer, but were stripped out when the Senate revised the legislation.
It would expand the reach of health savings accounts, a way for individuals to set aside pretax money to pay their health care costs directly, though unlike the bill that stalled in the Senate this week, it would not offer federal money for the accounts.
The bill would allow funding starting in 2027 for a kind of Obamacare subsidy known as “cost-sharing reduction payments.” That money, which Mr. Trump canceled during his first term, would go to insurers to help lower the cost of some individual insurance premiums while also reducing the generosity of subsidies that help people buy coverage.
Changes to the rules for pharmaceutical benefit managers have bipartisan support, and a package to restrict some of the industry’s profit-maximizing strategies came close to becoming law in the waning days of the Biden administration. But the bill differs in a few ways.
Republicans have long championed the idea of association health plans, a way for small businesses to team up so they can purchase the kind of insurance that is available for larger companies. Insurance markets for small businesses have become troubled in many states, and the plans are often very expensive for small companies and their workers.
But Democrats have tended to dislike the solution because it could allow small businesses with younger, healthier workers to exit insurance markets, further increasing costs for workers in industries with workers who are older and sicker.
Megan Mineiro contributed reporting.
Michael Gold covers Congress for The Times, with a focus on immigration policy and congressional oversight.
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