Health care costs become a political flashpoint as the House rolls out its own plan after the Senate stalled. Speaker Mike Johnson, R-La., spoke with reporters outside his Capitol office on Thursday, December 4, 2025, as Democrats and Republicans spar over how to reduce costs and expand access.
With time running short, House Republicans released a package late Friday that would not extend the enhanced Affordable Care Act (ACA) tax subsidies. Instead, it includes a set of changes the party argues will improve access to health care for Americans.
If Congress fails to act, the subsidies for ACA marketplace plans — designed to make premiums more affordable — will expire at year’s end. That would likely cause premiums to rise substantially for millions of people who rely on these plans.
Democrats have been advocating for extending the enhanced tax credits to keep premiums from doubling or more. Those subsidies were first introduced in 2021 to broaden affordability and access to ACA marketplace plans, which themselves arose from the 2010 health reform package championed by President Barack Obama. Republicans have long criticized that reform.
With only four days left in the current session before lawmakers head into a holiday recess on December 19 (the Senate recesses on December 20), the House proposal focuses on several mechanisms aimed at lowering costs. These include allowing small businesses to band together to purchase insurance for their employees and imposing new requirements on pharmacy benefit managers to curb drug costs.
The plan also envisions federal payments known as cost-sharing reduction payments beginning in 2027 to help lower premiums for some lower-income Americans, while excluding plans that cover abortion.
House Speaker Johnson indicated that a vote on this package could happen next week, framing the move as addressing the core drivers of health care costs to improve affordability, access, and choice for Americans while aiming to restore integrity to the health care system.
Democrats criticized the proposal as harmful to everyday Americans. In a post on X, Democratic House Minority Leader Hakeem Jeffries characterized the plan as a “toxic” approach that fails to extend the expiring ACA tax credits and dismisses the needs of ordinary families.
In the Senate, a Democratic-led effort to extend ACA subsidies for three years was joined by a handful of Republicans but did not pass, and a separate Republican-backed plan also fell short of the 60 votes needed to advance.
President Trump has publicly argued for directing funds to people to help pay for care rather than subsidizing insurance plans through tax credits, saying the money should help individuals buy better health care directly.
In contrast, the Senate GOP’s proposal had suggested creating health savings accounts (HSAs) offering up to $1,500 for Americans earning below 700% of the federal poverty level, paired with high-deductible plans. The House version does not include that HSA element.
According to a KFF analysis, the average deductible for many ACA marketplace plans hovers around $7,000, highlighting the challenge of high out-of-pocket costs. Democrats opposed the Senate GOP bill, arguing it wouldn’t help people pay premiums and criticized provisions related to abortion and gender-affirming care.
Some Republicans warn that rolling back ACA subsidies could hurt the party in elections, citing campaign concerns from constituents. A number of GOP members in the House are exploring ways to extend subsidies, including efforts to force a floor vote despite objections from party leadership.
