As millions of Americans face the prospect of sharply higher health insurance premiums in 2026, a bipartisan coalition of 35 House members has introduced a comprehensive two-year healthcare framework aimed at preventing a looming affordability crisis.
Representatives Josh Gottheimer (D-NJ) and Jen Kiggans (R-VA) announced “CommonGround 2025: A Bipartisan Health Care Framework” on December 4, urging congressional leadership to vote on legislation extending health insurance premium savings by December 18, according to documents provided to congressional leaders.
The proposal comes as enhanced premium tax credits established during the COVID-19 pandemic are set to expire on December 31, 2025, threatening to more than double insurance costs for approximately 24 million Americans who purchase coverage through Affordable Care Act marketplaces.
The bipartisan plan proposes a two-phased approach to address the crisis:
Year One would extend enhanced premium tax credits for enrollees earning less than 600% of the federal poverty level—approximately $200,000 for a family of four—with a phase-out for those earning between 600% and 1000% of FPL. The framework includes new anti-fraud measures, such as implementing the Insurance Fraud Accountability Act to impose civil and criminal penalties on fraudulent agents and brokers, and requiring ACA marketplaces to regularly confirm enrollee eligibility with the Death Master File.
The proposal also incorporates pharmacy benefit manager (PBM) reforms that would ban “spread pricing” in Medicaid, delink PBM compensation from medication costs in Medicare Part D, and promote transparency for employers and patients in prescription drug plans.
Year Two would require Congress to vote by July 1, 2026, on more significant healthcare reforms, with options including Medicare physician fee schedule increases, hospital billing transparency requirements, elimination of zero-dollar premiums with need-based hardship support, and the implementation of Health Savings Accounts based on a proposal from Senator Bill Cassidy (R-LA).
Senate Democrats have scheduled a vote for December 11 on a clean three-year extension of enhanced premium tax credits. Senate Minority Leader Chuck Schumer announced the straightforward extension, stating that “Republicans have one week to determine their position”. However, the proposal requires 60 votes to advance and is widely expected to fail, as it lacks sufficient Republican support.
Republican Alternatives have emerged from multiple corners of Congress, though no unified GOP position has materialized. Senator Bill Cassidy (R-LA), chair of the Senate Health, Education, Labor and Pensions Committee, has proposed redirecting enhanced premium tax credit funding into Health Savings Accounts that could be used for out-of-pocket healthcare costs but not premiums.
Senator Josh Hawley (R-MO) introduced the “No Taxes on Healthcare Act,” which would allow all taxpayers to deduct up to $25,000 per person in out-of-pocket medical expenses, including health insurance premiums, moving the deduction “above the line” so it would be available to all taxpayers, not just those who itemize.
Representative August Pfluger (R-TX), chair of the Republican Study Committee, unveiled the “More Affordable Care Act” on December 5, which would allow states to opt out of major ACA provisions through waivers and redirect federal premium subsidy dollars into “Trump Health Freedom Accounts”—HSAs that could be used for premiums or other healthcare costs.
During his first term, President Donald Trump repeatedly promised a healthcare plan was coming “in two weeks” or “very soon,” but never delivered a comprehensive replacement for the Affordable Care Act. In his current term, Trump has again voiced support for healthcare changes but has not proposed a specific, detailed plan of his own. In late November 2025, the White House circulated a draft proposal for a two-year extension of enhanced premium tax credits with modifications.
However, this proposal faced immediate Republican opposition and was quickly withdrawn. Trump then stated he does not want to extend the subsidies but “understands it might be” necessary, creating confusion about his actual position.
Speaker Mike Johnson (R-LA) told reporters on December 4 that GOP leaders would present their healthcare package the following week, though specific details have not been finalized.
The Senate HELP Committee held a hearing on December 3 titled “Making Health Care Affordable Again: Healing a Broken System,” where members from both parties acknowledged the urgency of the situation but disagreed on solutions.
Senate Majority Leader John Thune (R-SD) promised Democrats a healthcare vote in mid-December as part of an agreement to end the 43-day government shutdown in November. However, Thune acknowledged on December 4 that he does not see “a clear path forward” and that Republicans are still deliberating whether to propose their own legislation.
The 35 House members backing CommonGround 2025 have requested a meeting with congressional leadership to discuss their framework.
