House Republicans struggle to craft health care plan as tax credit deadline approaches

Washington — House Republican leaders vowed to hold votes next week on legislation to address rising health insurance premiums as more than 20 million Americans face skyrocketing costs when Affordable Care Act tax credits expire at the end of the year. 

But GOP leaders have made few details public about the policies they plan to take up, or whether the House will vote on an extension of the expiring tax credits before Dec. 18, their last scheduled day in session this year. 

House Majority Leader Steve Scalise, a Louisiana Republican, said Wednesday morning they will put "a number" of bills on the floor "that we have a consensus on."

"There's still some areas that we don't have full agreement upon, and we're going to keep working on those, and we've committed to work on those early in the next year," Scalise told reporters. "But starting next week, voting in the House on bills that will focus on lowering premiums for 100% of Americans." 

Scalise said leaders have been meeting with different factions of the conference for weeks to try to find a consensus. 

Democrats have remained firm in their push for a three-year extension of the tax credits. House Minority Leader Hakeem Jeffries has tried to force a vote on the issue, but a discharge petition to circumvent Republican leaders and bring it to the floor needs support from at least four GOP members. Jeffries, a New York Democrat, has said a three-year extension is the path forward that would attract "the greatest number of votes" in both the House and Senate.

A vote on a three-year extension is expected Thursday in the Senate, but it's all but certain to lack the 13 Republican votes it needs to advance. The upper chamber will also vote on a Republican proposal that does not include an extension. 

Republicans in both chambers have said that a three-year extension is off the table, stressing the need for reforms to tamp down on fraud and impose income limits for beneficiaries. They've also dismissed a shorter extension without any reforms. 

"There is no way that members of the House Republican conference are going to do a clean extension," Republican Rep. Mike Flood of Nebraska told reporters last week.

Premium costs are expected to increase by an average of more than $1,000 annually without the tax credits, according to the Center on Budget and Policy Priorities. And KFF estimated that the expiration of the tax credits would more than double annual premiums, from $888 on average in 2025 to $1,904 in 2026.

Moderates in both parties have been trying to break the stalemate and have floated several bipartisan frameworks to address the expiring subsidies. 

A bipartisan proposal from Reps. Josh Gottheimer, a New Jersey Democrat, and Jen Kiggans, a Virginia Republican, includes a one-year extension of the tax credits with income limits, followed by a second year with "more significant reforms," including eliminating $0 premiums, with need-based exceptions. Proponents of reform say that plans that require no premium payments from the consumer incentivize insurance companies to sign up customers, often without their knowledge, so the companies can collect the tax credit.

Republican Rep. Brian Fitzpatrick of Pennsylvania is leading another bipartisan proposal to extend the tax credits through 2027 with an income cap. The plan would expand access to health savings accounts, while also imposing a small monthly premium on the lowest-income beneficiaries. 

Fitzpatrick said the plan had bipartisan input from the House and Senate, as well as feedback from the White House. 

"So that's going to be our best product we can put together," he said last week. 

Fitzpatrick is trying force a vote on his bill by introducing a discharge petition — an increasingly common tactic used by rank-and-file members to bypass House leadership and put a measure on the floor if it can get a majority support. But that route likely needs the backing of most Democrats.