U.S. House Speaker Mike Johnson, R-La., talks with reporters inside the U.S. Capitol on Tuesday, Oct. 21, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Speaker Mike Johnson said Tuesday he will not allow a floor vote this week on a bipartisan amendment supported by moderate Republicans that would extend the Affordable Care Act enhanced tax credits. 

Johnson was confident that blocking the amendment would not lead centrist GOP lawmakers to oppose the Republican health care bill scheduled to get a vote Wednesday. 

“There’s about a dozen members in the conference that are in these swing districts who are fighting hard to make sure they reduce costs for all of their constituents. And many of them did want to vote on this Obamacare, COVID-era subsidy the Democrats created,” Johnson said. “We looked for a way to try to allow for that pressure release valve and it just was not to be.”

The enhanced ACA tax credits are set to expire at the end of the year, sharply increasing the cost of health insurance for the roughly 22 million Americans who purchase plans through the exchange and benefit from the subsidies. 

The House Republican health care bill wouldn’t extend those tax credits, frustrating GOP lawmakers in that chamber who are most at risk of losing their reelection bids during the November midterm elections. 

Johnson said he expects that GOP bill will pass, though he didn’t address its prospects in the Senate, where bipartisanship is needed for nearly all bills to advance under that chamber’s 60-vote legislative filibuster. 

The nonpartisan Congressional Budget Office and the staff of the Joint Committee on Taxation’s analysis of the bill shows it would reduce the federal deficit by $35.6 billion during the next decade. 

An average of 100,000 people per year would lose health insurance between 2027 and 2035, while  gross benchmark premiums for health insurance would drop by 11% on average through 2035, according to the joint analysis. 

‘Idiotic and shameful’

New York Republican Rep. Mike Lawler said in a speech on the House floor that GOP leaders’ decision to let the enhanced ACA tax credits expire was “idiotic and shameful,” especially after changes were added to address fraud and reduce costs. 

“So we have been forced to sign onto two discharge petitions,” he said. “And yet my Democratic colleagues will not join us, but for those that were at the negotiation table.”

Lawler then criticized House Minority Leader Hakeem Jeffries, of New York, for not encouraging Democrats to sign onto the bipartisan discharge petitions, noting that would likely get the 218 signatures needed to force a floor vote. He argued that’s because Jeffries “doesn’t actually want to solve the problem, he wants the issue.”

“This place is disgraceful,” Lawler said. “Everybody wants the upper hand.  Everybody wants the political advantage. They don’t actually want to do the damn work. This problem could be solved today if everybody who says they care about extending this signs the discharge.”

GOP-only bill in 2026?

When the House returns from its two-week holiday break next year, Johnson said, leaders may try to use the complex reconciliation process they used to enact the “one big, beautiful bill” to address health care. 

“What we anticipate going into the first quarter of next year is, possibly in a reconciliation package or in regular order a stand-alone, ideas just like this,” Johnson said after being asked a question about Health Savings Accounts. “We have a long list of things that we know will reduce premiums, increase access and quality of care.” 

President Donald Trump said Monday he wants Republicans to use the reconciliation process or to eliminate the Senate’s legislative filibuster to address health care and other policy priorities. 

“Republicans should knock out the filibuster and we should approve a lot of things,” Trump said. 

Senate Majority Leader John Thune, R-S.D., has said repeatedly he doesn’t intend to change or scrap the filibuster.

Direct payments or tax breaks

Trump also reiterated during the Oval Office event he would like to see Congress send direct payments to Americans to help them buy health insurance or afford health care. 

“I want all money going to the people and let the people buy their own health care. It’ll be unbelievable,” Trump said. “They’ll do a great job. They’ll get much better health care at a much lower cost.”

The Senate voted last week on two health care bills, one from Republicans and one from Democrats, but neither received the support needed to move toward a final passage vote. 

Republicans’ bill would have provided direct payments to some people enrolled in either bronze or catastrophic ACA marketplace plans with up to $1,500 in payments annually for 2026 and 2027. 

Democrats’ legislation would have extended the enhanced ACA marketplace tax credits for three years. 

Cost most urgent issue, poll finds

A bipartisan group of senators is trying to find solutions that bridge the political divide, though they are unlikely to achieve consensus on the details before the end of this week.

Thune said during a press conference Tuesday he believes there’s a way to address the rising costs of health care if Democrats continue negotiations with Republicans. 

“Our views on health care and the Democratic views on health care are very different. And I think that’s a difficult challenge that we have to figure out how to overcome,” Thune said. “But if they’re willing to accept changes that actually would put more power and control and resources in the hands of the American people and less of that in the pockets of the insurance companies, then I think there is a path forward.”

Thune acknowledged that Congress cannot pass anything this week but said he believes “there’s a potential pathway in January if Democrats are willing to come to the table on things that will actually drive down the costs of health care.”

Senate Minority Leader Chuck Schumer, D-N.Y., didn’t entirely rule out using the Jan. 30 government funding deadline to force a partial shutdown over health care, though he implied nothing can be done on the ACA tax credits after they expire at the end of December. 

“Once it expires, the toothpaste is out of the tube,” Schumer said. 

A poll released Monday by the West Health-Gallup Center on Healthcare in America shows that cost is the “most urgent” health issue facing the country, followed by access and then obesity. 

Just 57% of those polled said they were satisfied with how much they pay for their own health care and only 16% were satisfied with the total cost of health care.

Nearly two-thirds of those in the survey said they believe it’s the federal government’s responsibility “to make sure all Americans have healthcare coverage,” while 33% said it’s not. 

U.S. House Speaker Mike Johnson, R-La., talks with reporters during a press conference on Wednesday, Dec. 10, 2025. Also pictured are, from left, Republican Conference Chairwoman Lisa McClain of Michigan, Majority Whip Tom Emmer of Minnesota and Majority Leader Steve Scalise of Louisiana. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. House Republicans released a health care bill Friday evening they hope will help curb rising costs, though the measure doesn’t have the level of Democratic support needed to get through the Senate. 

The 111-page bill will likely move to the House floor next week, where Speaker Mike Johnson will need nearly every one of his members to vote to pass the legislation, an uphill battle given the vastly different views among centrists and far-right members of the party on health care issues. 

The Louisiana Republican said in a statement the bill offers “clear, responsible alternatives that will lower premium costs and increase access and health care options for all Americans.”

Democrats have been pressing for a three-year extension of the enhanced tax credits for people who purchase their insurance through the Affordable Care Act marketplace. 

So far, House and Senate Republican leadership hasn’t gotten on board with any extension of those subsidies, arguing they have led to a sharp rise in the cost of health insurance. 

GOP lawmakers have instead pursued their own legislation, but without at least some backing from Democrats, no bill will make it through the Senate’s 60-vote procedural hurdles. 

Senate Republicans tried to advance a bill earlier this week from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo but fell short of the votes needed. 

Democrats were also unsuccessful trying to move their bill to extend the ACA marketplace tax credits for three years. 

The House Republican bill, sponsored by Iowa Republican Mariannette Miller-Meeks, is unlikely to break the logjam in Congress over the rising cost of health insurance and health care, potentially leaving the issue as one the parties can debate leading up to next year’s midterm elections. 

Targeting ‘real drivers’ of cost increases

Johnson rebuked Democrats in his statement for enacting the Affordable Care Act during President Barack Obama’s first term, saying the law hasn’t made health care cost less. 

House Republicans’ new legislation, Johnson said, will address “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.”

The bill would require Pharmacy Benefit Managers “to provide employers with detailed data on prescription drug spending, rebates, spread pricing, and formulary decisions—empowering plans and workers with the transparency they deserve,” according to a summary in Johnson’s release. 

Starting in 2027, the legislation would appropriate funding for cost sharing reduction payments that the summary said would reduce health insurance premiums and stabilize the individual market. 

The House Rules Committee is scheduled to prepare the bill for floor debate on Tuesday by considering whether to allow any amendments to be considered on the floor. 

The full House will then debate the legislation later in the week before departing for the two-week holiday break. 

Trump wants direct payments

President Donald Trump, speaking from the Oval Office shortly after the bill was released, reiterated his preference that the federal government send payments directly to Americans.

“We want to give the money to the people and let the people buy their own great health care, and they’ll save a lot of money, and it’ll be great,” he said.

But Trump also appeared to signal he is going to stay out of negotiations in Congress, saying, “I leave it to them and hopefully they’re going to put great legislation on this desk right here.”