House Speaker Mike Johnson (R-La.) on Dec. 12 threw his weight behind the Lower Health Care Premiums for All Americans Act, one of several Republican proposals for lowering the cost of health care.

“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,” Johnson said when he asked lawmakers to support the plan.

The issue of health care has taken on increased urgency as certain Obamacare subsidies are set to expire at the end of the month.

Democrats and some Republicans, fearing that rising premiums will cause millions of Americans to lose health coverage, have pushed for an extension of the COVID-era enhanced subsidies.

Many Republicans argue that the Affordable Care Act, commonly known as Obamacare, is deeply flawed and that the subsidies themselves have driven the recent dramatic rise in insurance costs.

Senate Democrats and Republicans have been in a standoff over the matter since early in the fall, and last week, they failed to advance two competing plans to resolve it.

The Lower Health Care Premiums for All Americans Act, authored by Rep. Mariannette Miller-Meeks (R-Iowa), does not extend the expiring subsidies. Instead, it aims to expand choice in the health insurance market and reduce the price of health insurance.

House Minority Leader Hakeem Jeffries (D-N.Y.) has consistently said that the only viable way to avoid a dramatic increase in Obamacare premiums in 2026 is to extend the enhanced subsidies.

Here are the basics of the latest Republican plan.

Expand Access to Association Health Plans

Association health plans allow small businesses or groups to band together to purchase group health insurance. That allows them to leverage the buying power of a larger group to gain more affordable rates.

However, there are strict rules for which small businesses can join these plans, including a minimum number of employees.

This law would make it easier for small businesses and self-employed people to join association health plans. These plans cover pre-existing conditions.

Also, the group health plans offered through association health plans are regulated by the Employee Retirement Income Security Act, not the Affordable Care Act. That allows the association plans more freedom in designing the coverage offered.

The Department of Labor implemented a rule to widen the availability of Association Health Plans in 2018, but it was blocked by a court challenge, which claimed that the rule violated the Affordable Care Act. The Lower Health Care Premiums for All Americans Act would make these changes a matter of law.

Employer Contributions for Premiums

The first Trump administration created a rule allowing employers to contribute tax-free funds for workers to use to purchase health insurance that complies with the Affordable Care Act standards.

The proposed law would organize these arrangements through federal law rather than bureaucratic regulations and would give small businesses a tax incentive for participating.

The plans would be renamed Custom Health Option and Individual Care Expense arrangements, or CHOICE plans.

Reduce Regulations for Stop-Loss Insurance

Self-insured companies use their own funds to pay health insurance claims for employees, although those claims may be managed through a regular health insurer.

Self-insured companies that provide health coverage for more than 60 percent of their employees can use stop-loss insurance to protect themselves against major losses.

Some states put regulations on stop-loss coverage that make it harder for companies to offer self-insured plans.

The proposed law would clarify that stop-loss coverage is not health insurance and is not regulated by individual states, making it easier for companies to design and fund their own health insurance plans.

Pharmacy Benefit Manager Reform

Pharmacy benefit managers are the middlemen in the prescription drug supply chain. Insurance companies use them to negotiate drug prices with pharmaceutical companies, determine which drugs the insurer will offer, and set prices.

Using a practice known as spread pricing, the pharmacy benefit managers are able to negotiate discounts but don’t pass on the full amount to the buyer. Drug manufacturers have long complained that this practice lacks transparency and drives up prices.

This law would require pharmacy benefit managers to provide data on rebates, spread pricing, and formulary decisions.

This measure has bipartisan support. Sens. Mike Crapo (R-Idaho) and Ron Wyden (D-Ore.) recently introduced similar legislation in the Senate.

The Epoch Times requested comment from the Pharmaceutical Care Management Association, the trade association for pharmacy benefit managers, but did not receive a response.

Funding for Cost-Sharing Discounts

The Affordable Care Act mandates the reduction of cost-sharing amounts in silver plans for people who earn less than 250 percent of the federal poverty level. For a family of four, 250 percent of the poverty level is $80,375 per year. Silver plans are the second-least expensive plans and the most popular.

Cost sharing refers to things such as deductibles, co-pays, and out-of-pocket spending.

The idea was that the federal government would repay insurance companies for the amount by which they lowered the cost-sharing items for those participants.

However, the law did not appropriate any federal spending to cover that expense. As a result, health insurers simply raised the premiums on silver plans to recoup the loss from reduced cost-sharing.

The proposed law would provide federal funding for cost-sharing reductions starting in 2027, with the aim of lowering premiums.

“Relief would be better directed towards low-income enrollees that need them,” Johnson said.

The Congressional Budget Office estimated in 2019 that funding the cost-saving reductions would reduce the federal deficit by $29 billion over 10 years.

The House is expected to vote on the Lower Health Care Premiums for All Americans Act this week. The Senate on Dec. 11 rejected a Republican proposal that would have replaced Obamacare’s enhanced subsidies with Health Savings Accounts funded by the government.

It is unclear whether the Senate could take action on any proposal coming from the House before the end of the year.

“Progress, yes. Getting it done is going to be challenging,” Sen. Mike Rounds (R-S.D.) told reporters on Dec. 15.

“Around this country, there’s going to be a lot of pain,” Sen. Bernie Sanders (I-Vt.) told The Epoch Times, speaking of the impact of the expiring enhanced subsidies. “I hope that something can be done.”