Republicans offer their own health care plan. Will it help California consumers?

David Lightman, The Sacramento Bee on Dec 15, 2025

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House Republican leaders plan votes this week on their plan to reduce health care costs, but consumers shouldn’t expect much help with soaring premiums anytime soon.

The 111-page GOP blueprint, likely to get a House vote Wednesday, does not include an extension of the expiring health care premium subsidies.

Those credits for qualified consumers buying coverage through the Affordable Care Act’s marketplaces expire at the end of this month. Without the subsidies, premiums are expected to nearly double on average for California consumers using ACA plans.

The Republican legislation aims to reduce costs by making it easier for companies and self-employed people to join together to buy insurance, making pharmacy benefit managers’ actions more transparent and providing federal help to lower-income consumers buying health coverage.

“Most notable about the House Republican health care proposal is not what’s in it, but what’s not. This plan includes no additional federal help to make premiums or health care more affordable for people. This is like a greatest hits of Republican health care ideas from years past,” said Larry Levitt, executive vice president for health policy at nonpartisan KFF, which studies health care issues.

Opposition to Republican plan

Democratic leaders dismissed the Republican proposals as misguided and ineffective. “This so-called plan is the height of irresponsibility,” said House Minority Leader Hakeem Jeffries, D-New York.

A group of Republicans, mostly those seen as vulnerable in next year’s election including Reps. Kevin Kiley, R-Roseville, and David Valadao, R-Hanford, are seeking ways to extend the credits.

“We’re really going down the wire here,” Kiley told reporters. “We’re using all possible avenues to get an extension of these expiring tax credits by the end of the year.”

It’s not clear that an extension could pass the House, where Republicans outnumber Democrats 220 to 213.

Even if it does, it would still need Senate approval. Since 60 votes are needed to proceed with any such bill, and a proposed three-year extension got 51 last week, it’s considered unlikely a House extension would win there this week.

What’s in the Republican bill?

The new Republican plan includes elements familiar to the party’s proposals of the past. The GOP has tried to modify and even eliminate the ACA framework, known as Obamacare, since it was first adopted in 2010.

“Nearly 15 years ago, the Democrats’ Unaffordable Care Act broke the American health care system,” said House Speaker Mike Johnson, R-La., as he introduced the new GOP bill.

“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,” he said.

Among the bill’s features:

Pharmacy benefit managers. Long a target of Republicans, these managers connect pharmaceutical companies to insurers and say they aim to keep costs down. Critics say they actually are part of a system driving prices up.

The bill would require the managers to “provide employers with detailed data on prescription drug spending, rebates, spread pricing, and formulary decisions.”

This part of the plan has won bipartisan support because, Levitt said, it would increase scrutiny “of a largely unregulated part of the health care industry.”

Lower-income families. The bill would provide federal assistance starting in 2027 for those needing help.

“Relief would be better directed towards low-income enrollees that need them,” a bill summary says. Critics say help for paying premiums would be reduced under this plan.

Levitt said the proposal “would actually have the effect of increasing what many enrollees have to pay in premiums out of their own pockets by lowering premium assistance.”

Association Health Plans. Another longstanding aim of Republicans, this part would permit smaller businesses and self-employed workers to join together to buy coverage.

The idea of pairing up small businesses and self-employed people into a pool for purchasing coverage is designed to lower health care costs by spreading risks.

But, said Levitt, echoing other critics of this approach, “Expanding association health plans could allow these plans to cherry-pick healthier self-employed people, leaving the ACA marketplaces with a sicker pool of enrollees and higher premiums.”

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