GOP Centrist Brian Fitzpatrick Drafts Bill to Extend ACA Subsidies — Offering Conservative Concessions

Rep. Brian Fitzpatrick (R-Pa.), co-chair of the bipartisan Problem Solvers Caucus, is drafting legislation aimed at averting an imminent lapse in Affordable Care Act (ACA) premium tax credits while including provisions meant to attract conservative support.

Key elements under consideration

Fitzpatrick outlined several components he and fellow centrists are weighing: an extension of ACA tax credits with new income limits and required minimum premium payments; expanded flexibility for health savings accounts (HSAs), a longtime conservative priority; and a potential bipartisan effort to reform the role of pharmacy benefit managers (PBMs), though that part of the package may face delay.

Political dynamics and competing plans

The centrist draft is racing against conservative alternatives that would scale back or replace federal subsidies for marketplace plans with individual accounts, which supporters say would give consumers more flexibility. Fitzpatrick and his allies are open to HSA changes, but they insist the tax credits should not be allowed to expire. Many in the centrist group prefer first extending current subsidies and then pursuing broader reform.

At a private dinner Thursday, Fitzpatrick and other Problem Solvers members, including Rep. Don Bacon (R‑Neb.), discussed possible approaches. Bacon separately rolled out a bipartisan two‑year extension plan with GOP Rep. Jeff Hurd and Democratic Reps. Tom Suozzi and Josh Gottheimer that would extend subsidies but add new eligibility restrictions.

Leadership and legislative hurdles

House Majority Leader Steve Scalise said GOP leaders intend to bring measures such as HSA flexibility, PBM reform and cost‑sharing changes to the floor in the coming weeks, but he indicated those plans do not include an extension of the ACA tax credits. "There are a lot of really good ideas that we're going to be bringing to the floor for votes that lower premiums for families, bring more transparency and more options for families," Scalise said, adding that final decisions are still being worked through with the conference.

Centrists say they feel sidelined by party leaders who have leaned toward the conference's conservative wing and signaled openness to letting the subsidies lapse. They are also frustrated by moderate Democrats, who they say want broader negotiating frameworks before committing to short‑term fixes. Democrats, for their part, have pushed back on proposals to substitute individual spending accounts for the existing subsidies, warning such moves could leave many Americans worse off and destabilize insurance markets.

"We're going to have to move quickly," Fitzpatrick said of the effort to introduce a combined bill that balances short‑term relief with concessions designed to win GOP support.

The coming weeks look set to be a high‑stakes negotiation over whether to prioritize immediate subsidy extensions or to pursue a package of conservative reforms that leaders hope will lower costs in the longer term.