Energy and Commerce advances reconciliation health title after 26‑hour markup; key Democratic amendments fail

The House Energy and Commerce Committee advanced the health subtitle of the GOP budget reconciliation package after a 26‑hour markup that produced repeated recorded votes and sharp exchanges between members on both sides of the aisle.

The committee adopted an amendment in the nature of a substitute by voice and then voted to transmit the committee’s four‑subtitle reconciliation recommendations to the House Budget Committee. Chairman Guthrie presided over the markup and the committee clerk recorded final passage of the transmission motion by a roll call of 30 ayes to 24 nos.

The long session centered on whether provisions in the reconciliation text that alter Medicaid, the Affordable Care Act premium rules and other health funding items would reduce coverage or materially increase costs for patients. Democrats repeatedly quoted the Congressional Budget Office estimate cited in the hearing that, they said, 13.7 million Americans could lose coverage under the package; Republicans disputed that characterization and argued the changes protect the long‑term solvency of Medicaid and refocus the program on its original core populations.

Major amendments offered by Democrats and defeated in recorded votes included:

- An amendment to cap insulin at $35 per month for people with private insurance, offered by Rep. Schreyer. Rep. Schreyer described the amendment as “simple” and life‑saving for people with diabetes and urged colleagues to support it. The amendment was not agreed to (clerk reported 24 ayes and 29 nos; the chair announced the amendment failed). "It it would cap the cost of insulin at $35 for those with private health insurance," Rep. Schreyer said in debate.

- A proposal by Rep. Pallone to establish a $2,000 annual out‑of‑pocket cap on prescription drug costs for consumers with private insurance. Pallone framed the change as extending protections similar to those in Medicare Part D and the Inflation Reduction Act to the privately insured. That amendment was defeated in a roll call (clerk reported 24 ayes and 28 nos) after members debated the best route to lower drug prices.

- A bipartisan‑styled amendment presented by Rep. Ocasio‑Cortez and Rep. Ruiz to crack down on alleged “up‑coding” in Medicare Advantage and to reinvest identified savings to increase physician reimbursements. Supporters argued it would reclaim money from improper billing practices and strengthen Medicare for patients and providers; the committee rejected the amendment in a recorded vote (clerk reported 24 ayes and 28 nos).

- An amendment from Rep. Ocasio‑Cortez intended to trigger reinstatement of federal nursing‑home staffing ratio rules where adverse events were linked to inadequate staffing. Ocasio‑Cortez described systemic problems in for‑profit and private‑equity‑owned nursing homes and alleged industry diversion of funds away from patient care. The amendment failed in a roll call (clerk reported 23 ayes and 29 nos on a subsequent related vote).

- An amendment from Rep. Dingle to preserve home‑ and community‑based services (HCBS) funding and eligibility standards, and to maintain HCBS provider payments at no less than the rate in effect as of April 1, 2025. Dingle said the change was designed to prevent cuts to in‑home services for people with disabilities and seniors; the committee did not agree to that amendment (clerk reported 24 ayes and 28 nos).

Members also debated an amendment that would have required the Congressional Budget Office to certify that the bill would not worsen consumer medical debt; proponents linked higher out‑of‑pocket costs and coverage losses to increases in medical debt and bankruptcies. That amendment failed in a subsequent roll call.

Chairman Guthrie and several Republican members defended the package as necessary to curb waste, fraud and abuse in Medicaid and to stabilize program finances. Members on the Republican side repeatedly described provisions aimed at eligibility verification, cross‑state enrollment checks and community engagement requirements for the Medicaid expansion population as measures to protect the program for children, seniors and people with disabilities.

Democrats argued the bill’s combination of eligibility verification, provider‑payment changes and cuts to premium subsidies would make coverage less affordable and less accessible, increase uncompensated care at hospitals, and lead to higher costs and medical debt for families. Democratic members also repeatedly asked the committee to adopt narrower, targeted reforms such as caps on insulin and broader caps on out‑of‑pocket prescription spending; those amendments were recorded and defeated as described above.

After the recorded votes, the committee agreed by roll call to transmit the committee print and accompanying materials for the reconciliation directive to the House Budget Committee. The clerk reported the transmission vote as 30 ayes and 24 nos.

The markup included lengthy policy exchanges over the role of Medicare Advantage plans, physician fee schedules, nursing‑home staffing, home‑and‑community services, and whether the reconciliation vehicle should carry expansive policy changes to the nation’s health safety net. Committee staff on both sides and analysts from the Congressional Budget Office were repeatedly cited by members as sources for the cost and coverage estimates discussed during the session.

The committee’s action sends the health subtitle onward to the Budget Committee as part of the broader GOP reconciliation package; the full House process and potential floor votes remain to come.

Ending note: the committee’s adoption and transmission of the health subtitle begins the next legislative steps in the reconciliation process. Members on both sides signaled the fight over coverage, program integrity and the tradeoffs between deficit savings and access to care will continue as the package advances.