With health insurance premiums set to rise sharply for at least 22 million Americans who purchase their coverage through Affordable Care Act (ACA) marketplaces using tax credits that will expire at the end of this year unless Congress acts, the US House speaker Mike Johnson unveiled a Republican alternative late Friday.

Johnson’s bill comes as his party refuses to extend the enhanced tax subsidies for people who buy policies through the ACA, dubbed Obamacare by opponents of the 2010 law. Those subsidies help lower premiums for Americans who do not get insurance through employers.

Johnson, a Louisiana Republican, huddled behind closed doors to assemble the package for consideration next week as the House focuses the final days of its 2025 work on healthcare.

“House Republicans are tackling the real drivers of health care costs to provide affordable care,” Johnson said in a statement announcing the package.

Time is running out for Congress to act. Democrats engineered the longest federal government shutdown ever this fall in a failed effort to force Republicans to the negotiating table on healthcare. But after promising votes, the Senate failed this week to advance either a Republican healthcare plan or the Democratic bill to extend the tax credits for three years.

Now, with just days to go, Congress is about to wrap up its work with no consensus solution in sight.

The House Republicans offered a 100-plus-page package that focuses on long-sought Republican proposals to enhance access to employer-sponsored health insurance plans and clamp down on so-called pharmacy benefit managers.

Republicans propose expanding access to what’s referred to as association health plans, which would allow more small businesses and self-employed individuals to band together and purchase health coverage.

Proponents say such plans increase the leverage businesses have to negotiate lower rates. But critics say the plans provide skimpier coverage than what is required under the Affordable Care Act.

The Republicans’ proposal would also require more data from pharmacy benefit managers, or PBMs, as a way to help control drug costs. Critics say PBMs have padded their bottom lines and made it more difficult for independent pharmacists to survive.

Additionally, the Republican plan includes mention of cost-sharing reductions for some lower-income people who rely on Obamacare, but those do not take effect until January 2027.

The emerging package from the House Republicans does not include an extension of an enhanced tax credit for the millions of Americans who get insurance coverage through the ACA marketplace. Put in place in 2021 during the Biden administration, in response to the Covid pandemic, that enhanced subsidy expires 31 December, leaving most families in the program facing more than double their current out-of-pocket premiums and, in some cases, much more.

Donald Trump, speaking at the White House on Friday, said he believes Republicans are going to figure out a better plan than Obamacare – something he has promised for years – but he offered few details beyond his idea for providing Americans with stipends to help buy insurance.

The president had touted his proposal for sending money directly to Americans to help offset the costs of healthcare policies, rather than extending the tax credits. It’s unclear how much money Trump envisions. The Senate Republican proposal that failed to advance would have provided payments to new health savings accounts of $1,000 a year for adult enrollees, or $1,500 for people aged 50 to 64. That amount might not cover the increased premiums some Americans are facing in 2026 for even one month.

It appeared there were no such health savings accounts in the new House Republican plan.

Going Johnson’s route has left vulnerable House Republicans representing key battleground districts in a tough spot.

Frustrated with the delays, a group of more centrist Republican lawmakers is aligning with Democrats to push their own proposals for continuing the tax credits, for now, so that Americans don’t face rising healthcare costs.

They are pursuing several paths for passing a temporary ACA subsidy extension, co-sponsoring a handful of bills. They are also signing onto so-called discharge petitions that could force a floor vote if a majority of the House signs on.

Such petitions are designed to get around the majority’s control and are rarely successful, but this year has proven to be an exception. Lawmakers, for example, were able to use a discharge petition to force a vote on the release of the Jeffrey Epstein files held by the Department of Justice.

One petition, filed by Brian Fitzpatrick, a Pennsylvania Republican, had signatures from 12 Republicans and 12 Democrats as of Friday afternoon. It would force a vote on a bill that includes a two-year subsidy extension and contains provisions designed to combat fraud in the ACA marketplace. There are also restrictions for PBMs, among other things.

Another petition from Josh Gottheimer, a New Jersey Democrat, has 39 signatures and is broadly bipartisan. It is a simpler proposal that would force a vote on a one-year ACA enhanced subsidy extension and would include new income caps limiting who qualifies for the enhanced credit.

Both discharge petitions have enough Republicans’ support that they would likely succeed if Democratic leader Hakeem Jeffries encouraged his caucus to jump on board. So far, he’s not tipping his hand.

“We’re actively reviewing those two discharge petitions and we’ll have more to say about it early next week,” Jeffries said.

Meanwhile, Jeffries is pushing Democrats’ own discharge petition, which has 214 signatures and would provide for a clean three-year subsidy extension. No Republicans have signed onto that one.

And as Republicans made clear in the Senate this week, a three-year extension without changes to the program has no chance of passing their chamber.