Republicans are considering health care policy changes that could leave roughly 300,000 Americans without insurance as part of a broader effort to help fund a major budget package tied to military operations in Iran and immigration enforcement.
The proposal, discussed by GOP leaders including Jodey Arrington and Steve Scalise, involves adjustments to Affordable Care Act subsidies that would lower federal spending but increase out-of-pocket costs for some enrollees, leading to coverage losses.
Republicans are considering cuts to federal health spending to help cover costs in a budget bill that includes up to $200 billion for the war in Iran and immigration enforcement.
House Republicans are looking at changes to health programs, including steps to address fraud and waste in federal spending.
They also are revisiting an idea on Affordable Care Act payments.
House Majority Leader Steve Scalise said, “There’s other items we’re looking at right now, especially in the areas of fraud and waste and abuse that we’re working through with our members.”
Targeting ACA subsidies
House Budget Committee Chairman Jodey Arrington is reviving a plan considered last year on cost-sharing reductions in the ACA.
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As reported by Axios on Monday, March 30th, the Congressional Budget Office has said the change would lower benchmark ACA premiums by 11 percent but leave 300,000 more people without insurance.
It would reduce subsidies for some enrollees, raising their out-of-pocket premium costs, while saving the government more than $30 billion.
Discussions are in early stages. Republicans want the bill to be fully paid for. They plan to use the reconciliation process, which allows passage with a simple majority and avoids a Senate filibuster.
Democrats oppose funding for the Iran war and additional ICE operations.
Moderate Republicans have raised questions about the votes needed. Scalise said the party must put together a vote coalition. Rep. Don Bacon said he would review the details.
Push for offsets
Republicans have used similar health care offsets before. Last year’s budget law included deep cuts to Medicaid and new work requirements.
Arrington has also mentioned ideas for Medicare savings, such as equalizing payments between hospital outpatient facilities and doctors’ offices, and addressing upcoding in Medicare Advantage plans.
He noted concerns that such moves could be called cuts to Medicare.
On Medicaid, there is talk of limiting states’ ability to cover undocumented immigrants.
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President Trump has pushed for a “most favored nation” policy to tie U.S. drug prices to lower prices paid in other countries, though congressional leaders have shown little support for including it.
Arrington said he wants legislation passed in 60 to 90 days.
Democrats have criticized the approach. Sen. Elizabeth Warren wrote on X, “Republicans in Congress want to cut Americans’ health care to pay for more war in Iran.”
Why this matters
The proposed changes would directly affect health coverage for hundreds of thousands of people at a time when many already face high costs. The 300,000 figure comes from prior CBO analysis of the ACA subsidy adjustment.
If enacted, it would increase premiums for some current enrollees and leave others without insurance.
The budget bill ties these health adjustments to large new spending on the Iran war and immigration enforcement. Republicans argue the offsets prevent adding to the deficit.
The outcome will shape access to insurance for working families and set how Congress balances defense, immigration, and domestic programs in the current session.
