WASHINGTON — House Republicans on Wednesday passed a health care bill aimed at lowering health care costs and providing more options for employer-provided health insurance.

That news was overshadowed by a revolt earlier in the day by moderate Republicans who joined Democrats in forcing a vote on a bill to extend Affordable Care Act enhanced premium tax credits. Those credits are not part of the GOP health care bill. 

Republican leadership refused to allow a vote on an amendment to their health care bill that would extend the credits, with additional reforms to the subsidy program. Without the opportunity to vote on that amendment, four Republicans instead signed a Democratic-backed discharge petition for a clean three-year extension. 

The House Republican bill also doesn’t include funding for health savings accounts that are in the Senate GOP’s proposal to deal with the expiration of the ACA subsidies.

The health care bill that passed on Wednesday includes measures to make it easier for small employers to provide health insurance to employees. It also includes a measure to lower some ACA marketplace premiums, though the amount that most enrollees actually pay would rise, because of how subsidies are calculated.

Rep. Thomas Massie (R-Ky.) was the sole Republican to join Democrats in voting against the bill.

The Lower Health Care Premiums for All Americans Act would expand access to association health plans by allowing small employers and self-employed individuals to band together across industries to buy insurance that is less regulated. Large employers already can offer this kind of coverage. About 700,000 more people per year on average would choose association health plans under the bill, about 200,000 of whom currently don’t have insurance, according to the nonpartisan Congressional Budget Office.

Energy and Commerce Chair Brett Guthrie (R-Ky.) said small businesses often rely on ACA marketplace insurance, so Republicans are giving them additional insurance options. 

“We’re looking at how do we help employers have lower premiums, not just people in the marketplace,” Guthrie said during a House Rules Committee markup on Tuesday.

Democrats call the plans “junk insurance” and say they would raise premiums for ACA marketplace plan enrollees. Association health plans don’t have to cover essential health benefits, including pediatric care, hospitalization, and maternity care.

“That sounds to me like not a health care plan,” Joe Neguse (D-Colo.) said at the Rules Committee markup.

Another measure would prevent states from regulating stop-loss insurance that self-insured plans use to protect against large claims to control costs. 

It also would fund cost-sharing reductions for low-income enrollees in the Affordable Care Act marketplace. Funding cost-sharing reductions would lower gross premiums for benchmark silver plans by 11% on average, according to the CBO. Because ACA subsidies are based on the cost of a silver plan, that lowers the amount of tax credits available to buy any plan. 

The bill would not include the pandemic-era enhanced premium tax credits that Democrats seek, so it would only help silver plan enrollees who already didn’t qualify for the subsidies. Individuals enrolled in gold and bronze plans would likely pay more for their insurance, due to the reduced subsidies.

The bill includes bipartisan reforms to drug middlemen’s business practices, which would reduce government spending.

The CBO estimates the bill would reduce the deficit by $35.6 billion over the 2026-2035 period and decrease the number of people with health insurance by an average of 100,000 annually.