Speaker Johnson Unveils Healthcare Plan as Divided GOP Scrambles for Alternative

The Senate failed to get anywhere on the healthcare issue this week, leaving the House to show what it can do as the clock runs down.

Speaker Mike Johnson unveiled a Republican alternative late Friday in a last-minute sprint as his party refuses to extend the enhanced tax subsidies for people who buy insurance through the Affordable Care Act, also known as Obamacare, which are set to expire at the end of the year and currently help lower coverage costs.

Johnson, R-La., huddled behind closed doors Friday morning — as he did earlier this week — working to assemble the package for consideration as the House devotes the final days of its 2025 work period to healthcare.

“House Republicans are tackling the real drivers of healthcare costs to provide affordable care,” Johnson said in a statement announcing the package, adding that the legislation would be brought to a vote next week.

Time is running out for Congress to act after Democrats engineered the longest federal government shutdown ever this fall in a failed effort to force Republicans to negotiate on healthcare, followed by the Senate’s inability this week to advance either a GOP healthcare proposal or a Democratic bill extending the ACA tax credits for three years.

With just days remaining on the legislative calendar, Congress is poised to adjourn with no consensus solution in place.

House Republicans rolled out a 100-plus-page package centered on long-standing GOP priorities, including expanding employer-sponsored insurance options and increasing oversight of pharmacy benefit managers.

The proposal would expand access to association health plans, allowing small businesses and self-employed individuals to band together to purchase coverage.

Supporters argue those plans give businesses more leverage to negotiate lower rates, while critics say they often offer skimpier benefits than plans that comply with Affordable Care Act standards.

The legislation would also require additional reporting from pharmacy benefit managers, or PBMs, which Republicans say is necessary to rein in drug costs and curb practices critics argue have squeezed independent pharmacists.

The package includes references to cost-sharing reductions for some lower-income ACA enrollees, but those provisions would not take effect until January 2027 and do not prevent premium spikes next year.

Critically, Johnson’s proposal does not extend, replace, or preserve the enhanced ACA tax credits created during the COVID-19 pandemic, meaning millions of current enrollees would still see their subsidies expire on Dec. 31.

Those enhanced subsidies, enacted during the pandemic, have significantly lowered premiums for ACA marketplace consumers and their expiration is expected to more than double out-of-pocket costs for many families.

President Donald Trump, speaking at a holiday party at the White House, said Republicans would deliver a better alternative to Obamacare, reiterating a long-standing promise without offering specifics.

“We make beautiful, big payments directly to the people and they buy their own health insurance,” Trump said during Thursday night’s reception.

Trump has promoted sending money directly to Americans rather than extending ACA tax credits, though he has not specified funding levels or eligibility details.

The Senate GOP proposal that failed this week would have funded new health savings accounts with $1,000 annually for most enrollees and $1,500 for those ages 50 to 64.

There appeared to be no comparable health savings account provision in the new House Republican plan.

Johnson’s approach has put vulnerable House Republicans from competitive districts in a difficult political position.

Frustrated centrist Republicans are now aligning with Democrats to pursue temporary extensions of the ACA subsidies to prevent premium increases.

Those lawmakers are backing multiple bills and signing discharge petitions that could force floor votes if a majority of the House joins them.

Discharge petitions are rarely successful, but lawmakers earlier this year used one to force a vote on releasing Jeffrey Epstein-related files held by the Department of Justice.

One petition filed by Rep. Brian Fitzpatrick, R-Pa., had 24 signatures as of Friday afternoon and would force a vote on a two-year subsidy extension paired with ACA fraud-prevention measures and PBM restrictions.

Another petition from Rep. Josh Gottheimer, D-N.J., with 39 bipartisan signatures, would trigger a vote on a one-year subsidy extension with new income caps limiting eligibility.

Both petitions have enough Republican support to succeed if Democratic leader Hakeem Jeffries urges his caucus to sign on, though he has not yet done so.

“We’re actively reviewing those two discharge petitions and we’ll have more to say about it early next week,” Jeffries said.

Jeffries is instead pushing a separate Democratic discharge petition with 214 signatures that would enact a clean three-year subsidy extension.

As Senate Republicans made clear this week, a three-year extension without program changes has no path forward in their chamber.