OPINION:
Nearly half of Americans struggle to pay for health care, according to recent polling from independent health policy research organization KFF. If congressional Republicans hope to maintain their majority in the midterm elections this fall, then they need to address those concerns with credible, patient-centered reforms.
They have already begun to do so, though those efforts have been overshadowed by the Democrats’ pressure campaign to spend tens of billions of dollars extending COVID-19 enhanced Obamacare subsidies.
Late last year, House Republicans passed legislation that would do several things to make health insurance more affordable. One of them is expanding access to association health plans. These plans allow small businesses and self-employed workers to band together to purchase coverage in the large-group market, where it’s typically less expensive and more flexible than in the small-group market.
Larger risk pools make costs more predictable for insurers. That can translate into lower premiums. Small employers also gain bargaining power that they otherwise would not have on their own. That can improve their ability to negotiate better rates and benefits.
During President Trump’s first term, his administration finalized rules to expand access to association health plans that yielded savings of 23% to 29%, according to research from the Paragon Health Institute. The plans’ benefits were also more generous than those available on the exchanges. This success was short-lived, as the courts ended up blocking the rule.
The House bill also funds Obamacare’s cost-sharing reduction payments. The law directs insurers to reduce out-of-pocket costs for exchange enrollees earning up to 250% of the federal poverty level, or about $80,375 for a family of four.
Congress never appropriated funding for that purpose, so insurers have embraced a practice known as silver loading, in which they raise premiums for mid-tier silver exchange plans.
The second-lowest-cost silver plan, the “benchmark” plan, determines the level of federal subsidies for all exchange plans. Higher-cost silver plans mean higher subsidies across the board. That helps insurers recoup some of the costs of the cost-sharing reduction payments. It also encourages people to select more expensive coverage because taxpayers are picking up a bigger share of the tab.
Funding the cost-sharing reduction payments would eliminate all this regulatory arbitrage and reduce silver premiums by as much as 12%. That would also lower federal premium subsidies and save taxpayers more than $30 billion over 10 years.
Mr. Trump is on board with this idea. He included it in his recently released Great Healthcare Plan.
Another way House Republicans propose to expand access to affordable coverage is by codifying rules that allow employers to give employees money tax-free through “CHOICE” arrangements to purchase coverage on the individual market.
This approach benefits employers and employees alike. Employers can decide how much they can contribute without assuming the full cost and risk of sponsoring a group plan. Employees gain the freedom to choose coverage that fits their needs rather than accepting whatever plan an employer selects.
The health care debate in Washington has largely focused on whether to spend more taxpayer money to cushion consumers from rising premiums. That approach treats subsidies as a substitute for reform.
Republicans should make the case that affordability requires something different: regulatory changes that expand choice, increase competition and allow market forces to work.
House Republicans have already put forward legislation that would do just that. Now it’s time to see the job through.
• Sally C. Pipes is president, CEO and Thomas W. Smith fellow in health care policy at the Pacific Research Institute. Her latest book is “The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It.” (Encounter 2025). Follow her on X @sallypipes.
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