- The House passed the Lower Health Care Premiums for All Americans Act to expand association health plans and restore ACA cost-sharing reductions, aiming to lower premiums and widen workplace-like coverage options.
- The bill omits the enhanced ACA premium tax credits expiring after 2025, prompting four moderate Republicans to back a discharge petition for a three-year extension.
- CBO estimates the bill cuts the deficit by about $35.6B over 2026–2035 but reduces coverage by roughly 100,000 people per year on average.
- Polls show broad bipartisan support for extending the enhanced credits, and their lapse could more than double marketplace premiums for affected enrollees.
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The newly passed bill, Lower Health Care Premiums for All Americans Act, reflects a GOP strategy to reduce health insurance costs through structural changes rather than direct subsidy extensions. Key provisions include permitting small employers and self-employed individuals to band together across industries to purchase association health plans — less regulated than ACA plans — and restoring cost-sharing reduction payments in the ACA market.
However, the bill excludes the enhanced premium tax credits enacted during the pandemic that are set to expire at the end of 2025. This expiring feature is central to the political conflict, with moderate Republicans warning of steep premium increases for millions of marketplace enrollees if credits lapse. The public sentiment by polls underscores widespread concern across party lines.
On fiscal impact, the CBO estimates that the GOP bill will reduce deficit by about $35.6 billion over ten years, but at the cost of reducing coverage for roughly 100,000 people per year. The association health plan expansion is expected to shift some uninsured into regulated plans, but there is risk that others will lose protections and face higher out-of-pocket costs.
The political implications are significant: GOP leadership faces internal divisions, with moderates in swing districts breaking ranks to support subsidy extensions. These fractures may influence midterm elections. Also, while the House bill cleared, the Senate has already rejected both subsidy extension and GOP alternatives, signaling likely gridlock unless a compromise emerges.
Strategic open questions include whether there is a path forward for extending enhanced tax credits in the Senate, whether the bill will worsen disparities in insurance quality (especially via association health plans with fewer mandated benefits), and how voters will respond to rising premiums and enrollment losses.
Supporting Notes
- The House passed the Lower Health Care Premiums for All Americans Act on December 17, 2025; it expands access to association health plans but omits enhanced ACA premium tax credits currently expiring.
- Four moderate Republicans signed a Democratic-backed discharge petition to force a vote on a three-year extension of the ACA’s enhanced premium tax credits.
- The CBO estimates the GOP bill will reduce the federal deficit by approximately $35.6 billion over 2026-2035 while decreasing the number of insured persons by an average of 100,000 annually.
- Expanding association health plans under the bill is projected to add about 700,000 more individuals choosing such plans per year, of whom roughly 200,000 are currently uninsured.
- Restoring cost-sharing reductions would lower gross premiums for benchmark silver plans by about 11% on average, but this also reduces available tax credits since subsidies are tied to silver plan costs.
- Polls show 74-78% of the public favors extending enhanced premium tax credits, including majorities of Republicans and MAGA supporters, motivated by fears that average marketplace premiums will more than double if the credits lapse.