In a bid to reduce healthcare costs, House Republicans have unveiled a new legislation that proposes expanded insurance options for small businesses and unprecedented transparency requirements for pharmacy benefit managers.
The legislation, known as the Lower Health Care Premiums for All Americans Act, was introduced by Rep. Mariannette Miller-Meeks (R-Iowa-01) and is the Republican's response to Democratic proposals to extend expiring ACA premium tax credits that currently assist 22 million Americans in purchasing insurance.
According to RedState, the legislation is set to receive a floor vote next week as announced by Speaker Mike Johnson. However, GOP leadership has hinted that moderate Republicans seeking subsidy extensions may be granted an amendment vote, a move seen as a political maneuver rather than a realistic chance of passage.
The legislation's key feature is the codification of association health plans, a move that revives a Trump-era initiative that was struck down by federal courts in 2019 and formally rescinded by the Biden administration in 2024. The legislation allows groups or associations of employers, regardless of industry, to offer health insurance, provided they meet certain criteria. Self-employed individuals who work at least 10 hours weekly or 40 hours monthly in their business can join as both employers and employees, with a minimum of 20 self-employed members needed to form a group.
The legislation also includes protections that require plans to adhere to ACA nondiscrimination rules, which prohibit the denial of coverage for pre-existing conditions and health status-based premium variations. It also allows plans to establish base premiums using modified community rating across all participants, then adjust individual employer contributions based on specific risk profiles.
The legislation further expands health reimbursement arrangements that allow employers to fund employee purchases of individual market coverage instead of offering traditional group plans. Employers can offer different HRA amounts by employee class, with amounts varying up to 3-to-1 based on age and dependent coverage. The arrangements must be offered on identical terms within each class, and employers generally cannot offer both HRAs and traditional group coverage to the same employee class.
The legislation imposes extensive reporting requirements on pharmacy benefit managers, the intermediaries managing prescription drug benefits for insurers and employers. These requirements come into effect 30 months after enactment and include detailed reports to group health plans at least twice yearly.
The legislation also appropriates funding for Obamacare cost-sharing reductions beginning in 2027, reversing the Trump administrations 2017 decision to end these payments. GOP leadership aides have told reporters that appropriating CSR funding would reduce premiums by approximately 12 percent.
However, the legislation does not include any extension of enhanced ACA premium tax credits set to expire on December 31. These subsidies, expanded during COVID-19, help millions afford marketplace coverage but face fierce conservative opposition.
House Minority Leader Hakeem Jeffries criticized the package before its release, stating that he expected it "to be a disaster and actually not enhance the health care of the American people." In response, Johnson defended the GOP approach: "While Democrats demand that taxpayers write bigger checks to insurance companies to hide the cost of their failed law, House Republicans are tackling the real drivers of health care costs to provide affordable care, increase access and choice, and restore integrity to our nation's health care system for all Americans."
President Trump echoed this sentiment at a White House event on Friday, stating, "I want to see the billions of dollars go to people, not to the insurance companies. And I want to see the people go out and buy themselves great healthcare."
As Congress enters the final days of its 2025 legislative session, the fate of both the GOP package and enhanced ACA subsidies remains uncertain, with 22 million Americans facing potential premium increases. The Rules Committee is set to meet on Tuesday to finalize amendment procedures, potentially allowing moderate Republicans who signed discharge petitions seeking subsidy extensions an amendment vote.
However, such amendments would need near-unanimous Democratic support to pass and would likely kill the broader bill among conservative Republicans.
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