While half the country digs out from a blizzard, Congress is still fishing around for bipartisan solutions to improve healthcare and reduce consumer costs. Last week saw some progress on improving transparency, while bipartisan talks on revising and extending the enhanced premium tax credit (PTC) under the Affordable Care Act (ACA) appear to be stalled at the moment.

In mid-December, the Senate debated and rejected a Democratic bill to extend the enhanced PTC for three years. The chamber also voted down a GOP leadership alternative proposal that included repurposing PTC funding for new health savings accounts (HSAs) for individuals and transparency reforms for pharmacy benefit managers (PBMs).

In an effort to divert growing support for extending the PTC among Republicans, House Speaker Mike Johnson (R-LA) was able to win passage of the Lower Health Care Premiums for All Americans Act (H.R. 6703). That bill did not address the PTC, but did include GOP priorities like expanding association health plans, transparency requirements for PBMs, and cost-sharing reductions on the ACA insurance exchange.

While that bill narrowly passed the House, it did not prevent a handful of House Republican lawmakers from joining a discharge petition to force a vote on a three-year enhanced PTC extension. That bill actually passed the House in early January, providing a symbolic political victory for Democrats that marked the high-water point for extending the PTC. Since then, a bipartisan group of senators has been working behind closed doors in a valiant but likely doomed effort to find an agreement on a compromise that can pass Congress with bipartisan support. Senator Dick Durbin (D-IL), a key negotiator on this issue, put the best face on it, saying success is "possible but not likely."

President Trump then waded into the debate with his own healthcare reform proposal. It calls for diverting PTC tax subsidies into individual HSAs that consumers could use to purchase insurance or pay for health costs. The plan also targets price transparency reforms for PBMs and healthcare providers. The president's proposal, while important for getting a clearer picture of the administration's position on the issue, did little to affect negotiations on legislation that can pass Congress.

After weeks of little progress, Congress finally made progress on an issue that lawmakers from both parties support: more transparency for PBMs. To that end, last week House adopted an omnibus spending bill for FY 2026 (H.R. 7148) that includes a bipartisan set of PBM reforms, including: 

• Increased PBM transparency and standardized reporting requirements
• Disclosure of PBM finances, rebates, incentives, and formulary decisions
• Requiring summary documents for beneficiaries' cost and pricing structures
• The Senate is expected to approve the House-passed PBM reforms this week. 

It remains to be seen if the PBM reforms are the beginning or the coda on major healthcare reform in Congress this year. Some Republicans in Congress want to advance additional reforms via budget reconciliation, without the need to negotiate with Democrats. That route assumes Republicans can band together to force through partisan proposals with virtually no defections when it comes time to vote, especially in the House where the Republican majority hinges on just two votes. As the midterms approach, the political pressure to act could be the deciding factor. #TaxTake

Upcoming Speaking Engagements and Events 

Rocco will speak at PLI's International Tax Issues 2026 conference on February 25.

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