Miller-Meeks joins GOP leaders to push health care overhaul, blast Affordable Care Act

Iowa Republican U.S. Rep. Mariannette Miller-Meeks joined House Speaker Mike Johnson and other House GOP leaders Tuesday morning to promote a Republican health care proposal they say would lower insurance premiums nationwide and rein in costs they blame on the Affordable Care Act.

A nonpartisan Congressional Budget Office analysis found the House GOP health care bill would reduce federal deficits largely by cutting Affordable Care Act subsidies, while increasing the number of uninsured Americans despite lowering benchmark marketplace premiums.

At a Capitol press conference, Republicans outlined their case for H.R. 6703, the Lower Health Care Premiums for All Americans Act, framing the bill as a long-overdue alternative to extending Affordable Care Act subsidies championed by Democrats.

“This is a plan for working Americans, not for profitable insurance companies,” Miller-Meeks said, casting the proposal as a structural fix rather than another round of federal subsidies.

“It's about lowering costs, increasing access and restoring sanity to our health care system,” she said.

The House is expected to take up the bill Wednesday.

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Republicans cast ACA as a failed system in need of overhaul

Miller-Meeks, a physician and former Iowa Department of Public Health director, said her experience treating patients and working in public health shaped her opposition to the current system.

“I can tell you, thanks to the Democrats’ failed policy which they now admit, our health care system went from ill to the ICU,” Miller-Meeks said. “For 15 years, the ‘Unaffordable Care Act,’ also known as Obamacare, has done the opposite of what it promised.”

Miller-Meeks reiterated Republican claims that health insurance premiums and insurer profits have climbed sharply over the past decade, arguing that extending the enhanced premium subsidies enacted during the COVID-19 pandemic would largely benefit insurance companies while helping only a limited portion of Americans.

Roughly 22 million Americans receive enhanced ACA premium tax credits, with about 117,000 Iowans relying on advanced premium tax credits, according to nonprofit health policy research organization KFF.

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What the bill would do

The bill would expand association health plans, allowing small businesses and self-employed workers to band together to negotiate coverage, and strengthen “choice arrangements” that let employers make defined contributions toward employee insurance.

It would also exempt stop-loss insurance from federal regulation and override state laws that restrict their use by self-insured group health plans. Stop-loss insurance is designed to protect small employers from catastrophic claims that could otherwise overwhelm a self-insured health plan.

Supporters argue the change would make it easier for small businesses to self-insure while offering lower-cost coverage to employees. Critics, however, warn that expanded self-insurance could further fragment insurance markets.

“We're expanding Association health plans by allowing small businesses and self employed workers to team up to expand choices, which result in premiums going down by as much as 30 percent,” Miller-Meeks said. “Most importantly, it is a plan that lowers health care costs for everyone and puts patients and their doctors in the driver's seat.”

The legislation also would impose new disclosure and reporting requirements on pharmacy benefit managers aimed at increasing transparency around prescription drug pricing.

“We're delivering real PBM reform to stop middlemen from inflating drug prices,” she said, citing a PBM transparency law she sponsored as an Iowa state senator that she said helped one county save $80,000 in a single year.

CBO: Bill cuts deficit but increases number of uninsured

A nonpartisan Congressional Budget Office cost estimate released Tuesday found that the bill would reduce the federal deficit by about $35.6 billion over the next decade but slightly increase the number of uninsured Americans. The CBO estimated the legislation would result in an average of 100,000 more people without health insurance between 2027 and 2035, even as it reduced benchmark marketplace premiums by an average of 11 percent over that period.

The CBO estimated enrollment in association health plans would grow by about 700,000 people per year through 2035, including roughly 200,000 previously uninsured individuals. That expansion would increase federal deficits by about $2.9 billion over the period.

Other provisions would have relatively limited effects, according to the analysis. Changes to stop-loss insurance regulations would affect few people and have minimal budget impact. New disclosure requirements for pharmacy benefit managers could slightly lower prescription drug costs, but CBO projected those savings would reduce premiums by less than 0.1 percent initially and less over time.

The analysis found the bill’s largest effects stem from funding cost-sharing reductions for marketplace plans, which would end the practice known as “silver loading” in most states. The CBO said the change would reduce premium tax credits and lead to lower enrollment because available tax credits would cover a smaller share of premiums for non-silver plans than under current law. That would result in an estimated 300,000 more uninsured people each year.

Overall, the CBO concluded the bill would reduce federal deficits largely by cutting premium tax credit spending, rather than by expanding coverage.

Democrats argued Miller-Meeks has backed policies they said would cut Medicaid, threaten rural hospitals and allow health insurance costs to rise, calling the GOP plan a last-minute proposal unlikely to pass that would weaken preexisting-condition protections without addressing imminent premium increases.

Health policy experts warn that the bill’s approach could reduce premium tax credits for many enrollees and push more consumers into lower-value plans with high deductibles and cost-sharing requirements.

Johnson cites fraud findings, urges GOP unity behind overhaul

Johnson echoed Miller-Meeks’ criticism of the Affordable Care Act, accusing Democrats of refusing to work with Republicans on reforms and presiding over what he called rampant waste and fraud in the system.

Johnson cited a Government Accountability Office report that found weaknesses in ACA guardrails designed to prevent fraud, including payments made on behalf of deceased individuals and fictitious applicants.

“All Americans deserve a health care system that puts patients first — one that meets their needs with more access, more choice and more affordable quality care,” Johnson said.

Johnson contrasted the Republican plan with Democrats’ proposal to extend enhanced ACA subsidies, which he said would benefit only about 7 percent of Americans while costing taxpayers $350 billion over 10 years.

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Johnson acknowledged internal Republican disagreements over whether to vote on extending ACA subsidies, particularly among members in swing districts. But he said the conference would unite behind the GOP bill.

“Instead of just trying to assist 7 percent of Americans, this is for 100 percent of Americans,” Johnson said.

On Tuesday, Republican Iowa U.S. Sen. Chuck Grassley declined to say whether he would support Miller-Meeks’ legislation if it made its way to the Senate, but said he is not in favor of extending ACA subsidies.

“I voted to send money directly last week, and Democrats blocked it, so I don't know what's going to happen, and except for just generalities, I don't know what the White House is going to do,” Grassley said on a call with reporters Tuesday.

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Last week, Grassley and Republican Iowa U.S. Sen. Joni Ernst voted to advance a GOP health care proposal aiming to expand health care savings accounts instead of extending ACA subsidies, which failed to reach the required 60 votes. The Senate is currently at a standstill after it also voted down a Democratic bill to extend subsidies for at least three years ahead of their Dec. 31 expiration date.

Grassley said he is aware of a group of lawmakers who are trying to move another piece of legislation before the year ends, adding that ACA subsidies for people earning less than 400 percent of the federal poverty will continue next year.

Iowa farmers warn of looming coverage cliff

The debate comes as Iowans who rely on the Affordable Care Act marketplace face uncertainty over the possible expiration of enhanced subsidies at the end of the year. More than 136,000 Iowans purchased ACA coverage this year, and many are bracing for sharp premium increases in 2026 if the subsidies lapse.

Some Iowa farmers say the possible expiration of the premium tax credits could force many to go without health insurance or accept sharply reduced coverage, threatening the viability of family farms. An estimated 27 percent of farmers rely on the ACA marketplace, according to nonprofit health policy research organization KFF. It estimates subsidized enrollees would see their monthly premiums more than double if the credits lapse.

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Marion County farmer Matt Russell, executive director of the Iowa Farmer’s Union, said the ACA allowed farmers and small business owners to pursue livelihoods without needing off-farm jobs for health benefits, warning that Congress’ inaction could reverse that progress.

Russell said House Republicans’ health care bill fails to address the immediate premium spike many expect next year.

“If that’s their plan to address what we’re facing with the expiration of the enhanced premium tax credits, then they’re basically saying: you’re on your own for ‘26,” he said in a statement.

Lee Des Moines Bureau Chief Maya Marchel Hoff contributed to this report.

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