House Republican leaders released draft legislation Friday consisting of a package of health proposals aimed at reducing health care costs in 2026, setting up a possible floor vote this week. The House Rules Committee is scheduled to meet Tuesday afternoon to consider the bill for floor action. The 111-page bill combines a slate of measures Republicans say will address health care affordability, such as expanding access to association health plans, which allow employers across industries to buy coverage as a group and thereby trim costs. It would also require more transparency from pharmacy benefit managers and fund so-called cost-sharing reduction payments that the first Trump administration canceled in 2017. The release of the bill text follows efforts by Republicans last week to resolve outstanding issues on what should be included. Lawmakers are facing a time crunch on health care affordability, with less than a week before a scheduled recess and expiration on Dec. 31 of enhanced Affordable Care Act subsidies. The end of those subsidies is expected to fuel much higher premiums for about one-third of ACA marketplace enrollees. The bill does not address those tax credits, despite pressure from some moderate House Republicans to include an extension. “While Democrats demand that taxpayers write bigger checks to insurance companies to hide the cost of their failed law, House Republicans are tackling 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,” Speaker Mike Johnson, R-La., said in a statement. The legislation is sponsored by Rep. Mariannette Miller-Meeks, R-Iowa, who is facing a tough reelection bid in a race rated as a "Toss-up" by Inside Elections with Nathan L. Gonzales. President Donald Trump in November endorsed Miller-Meeks for the seat. The bill, starting in 2027, would reverse the cancellation of cost-sharing reduction payments to insurers that occurred in 2017. These cut some enrollees' out-of-pocket expenses, through lower deductibles and copays. The plan would impose new transparency measures on pharmacy benefit managers, the middlemen that negotiate drug costs between pharmacists and drug companies. They would have to provide employers with detailed reports on prescription drug spending, drug rebates, formulary decisions and what is known as spread pricing — a practice in which PBMs charge health plans more for a drug than they pay for it. The bill would also clarify current law to stipulate that stop-loss insurance policies should not qualify as health insurance, which Republicans say would shield small businesses from catastrophic claims. Expanding access to association health plans has been among Republicans' preferred proposals. The plans allow small businesses to band together to purchase insurance, a move that helps lower costs for employers. But those plans typically aren’t held to the same requirements as ACA plans, like a mandate to cover “essential health benefits” such as prescription drugs or preventive health care. The bill left out any proposals to fund health savings accounts for ACA enrollees, an idea favored by Senate Republicans that fell short in a procedural vote on Thursday. The House bill is set to be considered at the Rules panel Tuesday alongside two separate bills related to restricting gender-affirming care for minors.
