After months of delay, including a weekslong shutdown, Speaker Mike Johnson, R-La., and his leadership team finally unveiled the House GOP’s health care proposal. In theory, the bill would address the massive health care cost increase looming as a set of enhanced Affordable Care Act subsidies expires. Instead, in the last work week of the year, Johnson has managed to draft a bill that nobody seems to like — including Republicans.
It’s the sort of cut-and-paste job that might be on the topic broadly, but still fails to address the actual question at hand.
If the goal was, as my colleague Steve Benen argued, to at least check the box showing the GOP contributed something to the debate over the expiring subsidies, then the bill was a success. If the goal was to draft a law that would address the immediate problem of Obamacare premiums due to double on average for 22 million Americans, it was much less successful. The bill as drafted neither addresses the expiring subsidies nor offers an alternative to prevent the rapidly approaching spike in costs.
The bill also doesn’t include any expansion of health savings accounts, one of the few policy proposals that has made its way into multiple Republican-driven pitches across the Capitol. Instead, the “Lower Health Care Premiums for All Americans Act” is an extremely narrow bill made up of health care-related policies that congressional Republicans have previously supported over the years. It’s the sort of cut-and-paste job that might be on the topic broadly, but still fails to address the actual question at hand.
Johnson is being confronted again with the wide gap between his party’s politics and its policies. As Politico put it Monday, Johnson and his team “have been unwilling to rethink a 15-year-old party message that Obamacare is a costly disaster, despite growing anxiety from their members about the electoral consequences.” The dogmatic thinking on display leaves little room to develop creative policies within the existing ACA system, leading to the shoddy, quick-fix alternatives that the GOP has slapped together.
Many of those moderate members, whose swing-district seats are prime targets for Democrats, are certain that ripping the proverbial Band-Aid off with the subsidies is a surefire way to lose the midterms next year. Johnson himself seems to acknowledge that his bill isn’t exactly a surefire bet for his caucus’ support. As MS NOW’s Mychael Schnell and Kevin Frey reported Monday, in what’s become a rarity for House votes, the speaker planned to leave the door open to the bill being changed substantially:
But as a concession to moderate Republicans concerned about the political fallout of letting the subsidies lapse, Johnson is allowing a vote on an amendment based on a bipartisan bill from Rep. Brian Fitzpatrick, R-Pa. His legislation would extend the subsidies for two years and implement several other changes.
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What exactly that amendment will do, however, remains unclear. Two sources who were in a meeting with Johnson and leaders from across the conference on Friday told MS NOW that conservatives are pushing for even more changes to the Fitzpatrick amendment.
Or at least that was the plan. Punchbowl News reported Monday afternoon that the informal deal between Johnson and moderates collapsed. Instead, the new plan is for Fitzpatrick and his allies to pitch the amendment at Tuesday’s Rules Committee meeting in the (slim) hopes it will be included into the package when presented to the full House.
House Democrats, for their part, have been united in rejecting any proposal that doesn’t have a three-year extension for the subsidies baked in. There are still longshot hopes that a deal might be hammered out, but with only five days left before Congress scatters home for the holidays, it feels like a mistake to bet on it. And while Johnson said last week that the House would be spending the first half of 2026 “working on health care policy,” without an indication of what that will look like, there’s not a lot to inspire hope for the people struggling to afford their coverage.
Without an off-ramp to cushion the pain of the subsidies expiring, it’s not clear that this bill will even muster a majority when it hits the floor. If it does, it will be because GOP moderates choose once again to fall in line with Johnson even if the bill does little to address their political fears. Meanwhile, Republican hardliners who still deeply believe the anti-ACA gospel are mad that a vote on health care is happening at all. The lack of ACA subsidies in the current bill will likely get the archconservatives to support it, but that doesn’t mean much if the whole thing collapses before it can pass the House even on a party-line vote.
In total, Johnson has pulled off something remarkable. On the most pressing issue facing the House, he punted for weeks on addressing the subsidies before finally admitting that there’s a problem for lawmakers to address. And with only days left on the congressional calendar, he rolls out a bill that not only doesn’t fix the problem, but also barely manages to receive the (at best) begrudging support of his own party. It’s the kind of unimpressive legislative craftsmanship that only highlights both how dry the well is for Republicans on this issue — and how few experienced legislators the GOP still has available.
Hayes Brown is a writer and editor for MS NOW Daily.
