House Republicans have introduced a new health care package aimed at lowering costs through regulatory reforms rather than extending federal tax credits.
The bill, titled the Lower Health Care Premiums for All Americans Act (H.R. 11), was introduced by Rep. Mariannette Miller-Meeks (R-IA) just days after the Senate failed to advance competing proposals to address expiring health care subsidies.
With millions of Americans facing potential premium spikes when the enhanced tax credits sunset on December 31, 2025, the new House measure signals a distinct pivot away from the subsidy-focused debate that has paralyzed the upper chamber.
On December 11, the Senate rejected two dueling measures intended to mitigate rising health care costs, leaving lawmakers with little time to avert a “premium cliff” before the holiday recess.
A Democratic proposal to extend the enhanced ACA premium tax credits for three years failed to reach the 60-vote threshold, falling in a 51-48 vote despite support from four Republicans—Sens. Susan Collins (ME), Lisa Murkowski (AK), Dan Sullivan (AK), and Josh Hawley (MO).
Moments later, a Republican alternative also failed by a 51-48 margin. That measure sought to replace the tax credits with annual contributions of $1,000 to $1,500 into Health Savings Accounts (HSAs) for eligible individuals and included Medicaid policy changes.
The newly unveiled House package, H.R. 11, eschews a direct extension of ACA subsidies. Instead, it aggregates several GOP policy priorities designed to increase competition and transparency in the health care market.
According to the bill’s text, the legislation focuses on three primary pillars:
1. Expanding Association Health Plans (AHPs)
The bill would amend the Employee Retirement Income Security Act (ERISA) to make it easier for groups of employers—including those in different industries—to form Association Health Plans.
- Key Provision: Associations would need to cover at least 51 employees and have a formal organizational structure with a governing board controlled by employer members.
- Self-Employed Access: The bill explicitly allows self-employed individuals to participate in these plans, treating them as both employers and employees for legal purposes, potentially opening up group rates to freelancers and gig workers.
2. PBM Transparency and Oversight
Title II of the bill targets Pharmacy Benefit Managers (PBMs), the middlemen who negotiate drug prices.
- New Reporting Requirements: PBMs would be required to submit semi-annual reports to group health plans detailing the net spending on drugs, the amount of rebates received from manufacturers, and out-of-pocket spending by patients.
- “Spread Pricing” Disclosure: The bill mandates transparency regarding the difference between what a PBM pays a pharmacy for a drug and what it charges the health plan, a practice known as “spread pricing.”
3. CHOICE Arrangements
The legislation introduces “Custom Health Option and Individual Care Expense” (CHOICE) arrangements. These are employer-funded plans that reimburse employees for medical care or individual market premiums, provided the employee is enrolled in individual health insurance or Medicare. This aims to give employers more flexibility in how they subsidize worker coverage without managing a traditional group plan.
With the House scheduled to recess on December 19 and the Senate following on December 20, Congress has less than a week to reconcile these vastly different approaches. If no action is taken, the enhanced subsidies—originally expanded during the pandemic—will expire on New Year’s Eve, potentially leaving millions of Americans with significantly higher bills in 2026.
