The GOP Healthcare Menu

Slow news weekend, so we'll post a story by Nathaniel Weixel of The Hill on his divination of GOP healthcare plans.  Weixel isn't exactly a nonpartisan observer, even though he would like you to believe he is an independent journalist. So take his prognostications with a large lump of salt:

https://thehill.com/policy/healthcare/5624197-aca-subsidies-republican-options/

What’s on the GOP menu for ObamaCare reform, subsidy extensions
By Nathaniel Weixel - November 27, 2025

Twenty-four million Americans are facing spiking health insurance prices because of expiring enhanced Affordable Care Act (ACA) subsidies that Republicans have so far refused to extend.

Lawmakers are divided on the way ahead, with the deadline to sign up for 2026 coverage on Dec. 15.

GOP leaders are faced with competing proposals across the House and Senate but the same political dilemma: Either they extend the subsidies and endorse ObamaCare, which Republicans have long opposed, or they let the subsidies expire ahead of next year’s midterms and deal with the electoral fallout.

Some want a deal to preserve the enhanced subsidies, heading off voter ire and preventing an election-year nightmare scenario for the GOP. Others want the enhanced subsidies to expire and be replaced by direct cash to Americans, convinced they can blame Democrats for high costs.

No matter what happens, the law’s underlying subsidies that help people afford premiums will continue past year’s end. But the expiration of the enhanced subsidies, enacted during the COVID-19 pandemic, means millions will see higher monthly payments.

Here’s what’s on the GOP menu, and who is behind it:

House front-line and moderate GOP

One bill comes from Reps. Don Bacon (R-Neb.), Tom Suozzi (D-N.Y.), Josh Gottheimer (D-N.J.), and Jeff Hurd (R-Colo.).

Their bill would extend ObamaCare’s enhanced subsidies for two years, along with some changes to try to assuage conservatives’ concerns about fraud.

The bill would extend the enhanced tax credits through 2027 for enrollees earning less than $200,000 per year for a family of four, and it would phase out the subsidies for enrollees earning between $200,000 and $300,000 for a family of four.

It would also create new guardrails to prevent “ghost beneficiaries” — ObamaCare enrollees who don’t have any health care claims. It’s one of the main criticisms Republicans have of the subsidies, and they argue it’s an indication of widespread fraud.

The bill would codify the federal government’s authority to remove bad actors from ACA marketplaces and require marketplaces to regularly confirm enrollee eligibility and that enrollees haven’t died.

The bill would also extend open enrollment to May 15 as a recognition that many would-be recipients may have been discouraged from purchasing health insurance by sticker shock over high premiums.

Separately, Bacon joined another small bipartisan group led by California Reps. Kevin Kiley (R) and Sam Liccardo (D) to back a two-year subsidy extension with an income cap that includes a pay-for. It seeks to create savings by cutting “excessive Medicare Advantage payouts to insurers” through the common practice of “upcoding.”

Rep. Jen Kiggans (R-Va.), who’s facing a tough reelection contest, has her own bill promoting a one-year extension. It’s been endorsed by 14 other GOP lawmakers.

Sen. Bill Cassidy (R-La)

The plan from Cassidy, chair of the Senate Health, Education, Labor and Pensions Committee, would let the enhanced subsidies expire.

Congress would then use that funding to deposit money directly into savings accounts (HSAs) for people who buy high-deductible plans on ObamaCare exchanges. The original subsidies would still go toward marketplace premiums.

Giving people HSAs has been a favorite idea among Republicans for years, and it was a key part of the party’s 2017 ACA replacement bills in the House and Senate. The idea appeals to Republicans who want to promote free market competition in health care.

Cassidy argued that offering HSA funds to a patient directly cuts out the insurer and empowers a patient to make their own choices for healthcare.

“We don’t have to be paternalistic,” he said during a recent Finance Committee hearing on health costs.

Cassidy’s plan is not the official Republican position, and he hasn’t released legislation yet. But it aligns with a demand by President Trump to end the enhanced subsidies and send money directly to consumers.

His idea takes advantage of a change made possible by the GOP’s One Big Beautiful Bill Act, which allowed ObamaCare “bronze” plans to be eligible for HSAs. Bronze plans feature lower premiums but high deductibles and only 60 percent coverage for medical expenses.

HSAs can’t be used to pay for monthly premiums, and critics argue that they won’t help if someone can’t afford the underlying cost in the first place. They also are of little help for someone with an expensive medical condition like cancer or diabetes.

Cassidy said he doesn’t have a cost estimate, and he hasn’t worked out how to allocate the HSAs to consumers.

Prior to the Thanksgiving recess, Cassidy said his goal was to have a plan ready to go by mid-December, which is when Senate GOP leaders promised Democrats they would hold a vote on extending the enhanced subsidies.

Sen. Rick Scott (R-Fla.)

Like Cassidy’s idea, Scott’s legislation centers on health savings accounts and would let the enhanced subsidies expire.

But his proposal goes even further than Cassidy’s and could undermine the entire structure of the Affordable Care Act.

Scott’s bill lets states submit a waiver to the federal government to replace the base ACA premium tax credits and instead fund “HSA-style Trump Health Freedom Accounts.”

Unlike traditional HSAs, people could use the funds to pay for both premiums and health expenses. According to the bill, the payments would be effective starting Jan. 1.

According to health research group KFF, the “freedom accounts” could be used for any type of health insurance plan, including short-term plans that can exclude people based on pre-existing conditions, which is not allowed under ObamaCare.

States could also waive certain provisions of the ACA, including the requirement to cover certain benefits. Scott’s plan would allow insurers to sell plans across state lines, opening up the possibility of selling plans that don’t meet a state’s regulatory requirements.

Scott’s plan could lead to a collapse of the ACA marketplace in states that fund the freedom accounts. Healthy people would be able to buy less expensive coverage or skip insurance altogether and use their accounts to pay for health care directly.

People with expensive health conditions would only be able to get coverage from ACA exchange plans.

The White House

President Trump has been sending conflicting messages.

Earlier this month, he posted an all-caps message on Truth Social telling Congress not to “waste your time and energy” on extending the subsidies.

But then a leaked White House plan reported by various outlets was closer to the House moderates’ idea than the ones from Cassidy or Scott.

It involved temporarily extending the ACA subsidies, potentially for two years, while incorporating a series of guardrails, like income eligibility limits and a requirement that all enrollees pay some form of premium. Both those policies seek to address the allegations of fraud.

It also reportedly would have included some incentives for enrollees to choose a high-deductible plan and redirect some federal aid into a health savings accounts.

Yet the apparent trial balloon popped soon after it was leaked. The reports sparked backlash from Republicans, who have spent years railing against the law.

On Nov. 25, Trump told reporters on Air Force One he’d “rather not” extend the subsidies.

“Somebody said I want to extend them for two years. I don’t want to extend them for two years.

I’d rather not extend them at all,” Trump said. “Some kind of extension may be necessary to get something else done, because the un-Affordable Care Act has been a disaster.”