Speaker Mike Johnson had discussed the prospect of allowing more politically vulnerable GOP lawmakers a chance to vote on their amendment that would temporarily extend pandemic-era subsidies for ACA coverage. But after days of private talks, leadership sided with the more conservative wing of the conference, which has assailed the subsidies as propping up a failed ACA marketplace.

“We looked for a way to try to allow for that pressure release valve,” Johnson said Tuesday at the Capitol. “In the end, it was not — an agreement wasn’t made.”

The maneuvering surrounding the health care vote all but guarantees that many Americans will see substantially higher insurance costs in 2026. In the Senate, a bipartisan group was still trying to come up with a compromise to extend the subsidies, which fueled this year’s government shutdown. But senators made clear that any potential legislation would likely wait until January, after the holiday break.

Instead, House Republicans will pursue their 100-plus-page health care package that focuses on long-sought GOP proposals designed to expand insurance coverage options for small businesses and the self-employed. A test vote is expected Wednesday.

The Republicans’ package would clamp down on middlemen called pharmacy benefit managers who work to manage drug costs and process claims for insurance plans. The bill would also expand access to what’s referred to as association health plans, which would allow more small businesses and self-employed individuals to band together and purchase health coverage.

An analysis from the nonpartisan Congressional Budget Office and the Joint Committee on Taxation estimates the package would decrease the number of people with health insurance by an average of 100,000 per year over a 2027-2035 window, while reducing the federal deficit by $35.6 billion.

Failing to address expiring insurance subsidies ‘political malpractice’

Rep. Mike Lawler, R-N.Y., blasted the leadership’s decision to not allow for a vote to temporarily extend the health insurance subsidies, saying it amounted to “political malpractice.”

Lawler, who hails from a competitive district, noted that most people who get their health coverage through the Affordable Care Act live in states that President Donald Trump won and said the changes proposed for a temporary extension were “conservative reforms.” He also criticized Democratic leader Hakeem Jeffries for not pushing Democrats to support a pair of bipartisan extension efforts.

“You have two leaders who are not serious about solving this problem,” Lawler said of Johnson and Jeffries.

Still, the centrist Republicans indicated they would not try to block the Republican leadership’s measure from coming to a vote.

Johnson defended the House GOP’s bill, which includes priorities that Republicans have been working on for several years.

“We have a long list of things that we know will reduce premiums, increase access and quality of care,” Johnson said. “The Democrats have zero ideas, zero concepts and zero legislative plans on anything they’ll propose other than just subsidizing the broken system.”

Democrats said even if the bill passes the House, it will not pass the Senate, where it would need 60 votes and bipartisan support to advance. They said it was not a serious effort to address rising costs.

“Millions will be priced out of their coverage, and those who can still afford it will get less while paying more,” said Rep. Suzan DelBene, chair of the House Democratic campaign arm. “Republicans are ignoring the pain, the pain we’re seeing across the country for everyday Americans. And make no mistake, it is going to cost them the majority.”

GOP bill focuses on insurance options and cost-sharing

During Trump’s first term, his administration sought to expand access to association health plans that don’t have to offer the full menu of benefits required under current law. The option offers lower premiums for small businesses and self-employed people, but the policies are likely to cover fewer benefits. A federal judge who struck down the administration’s effort in 2018 said the plans were were “clearly an end-run” around consumer protections required by the Affordable Care Act, also known as Obamacare.

The House Republican plan would also restore government funding for cost-sharing reductions, or CSRs, a type of financial help that insurers give to low-income ACA enrollees on silver-level plans that reduces their share of costs like deductibles and copays.

From 2014 until 2017, the federal government reimbursed insurance companies for CSRs — but in 2017, the Trump administration stopped making those payments. To make up for the lost funds, insurance companies hiked premiums for silver-level plans — a complicated move that ended up increasing the financial assistance many enrollees get to help pay for premiums.

As a result, health analysts say that while restoring funding for CSRs would likely bring down silver-level premiums, it could also have the unwelcome ripple effect of increasing many people’s net premiums on bronze and gold plans.

The provisions related to pharmacy benefit managers require the middlemen to disclose certain data about their operations to group health plans, with the hope that more transparency would reduce prescription drug costs.

Senators revive talks of action in the new year

Almost two dozen Republicans and Democrats met late Monday to talk about a last-minute fix on the ACA tax credits after the Senate rejected two partisan health care bills last week. They emerged from the meeting discussing ways to end the stalemate, including a possible two-year extension of the subsidies with reforms that would narrow who could receive them. They also discussed adding some version of a GOP proposal to create new health savings accounts that would help people purchase insurance.

Maine Sen. Susan Collins, a Republican who led the bipartisan meeting, said the group would like to announce a proposal this week. But there were still significant unresolved issues, including whether to include stricter language on abortion funding. Disagreements over abortion were one of the main sticking points in earlier talks that derailed a compromise.

Senate Majority Leader John Thune said there’s a “potential pathway” to an agreement in January, but acknowledged, “we’re not going to pass anything by the end of this week.”

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Staff writers Mary Clare Jalonick and Ali Swenson contributed to this report.