WASHINGTON (AP) – The first person to call City Hall was Maryland Rep. Andy Harris, leader of the conservative House Freedom Caucus, with questions prepared about the Affordable Care Act. Her cousin’s disabled son is at risk of losing his insurance. under that lawsaid the person on the phone.
“Right now, she’s paying two to three times as much in premiums as she used to,” said a woman who identified herself as Lisa from Harford County, Maryland. “I would really like some clarification on the Republican health insurance plan.”
Harris, a seven-term Republican, didn’t have a clear answer. “I think the solution is to do something to make sure that all premiums are lower,” he said, predicting that Congress would “probably negotiate some reductions” later.
His uncertainty reflects a common Republican dilemma. Fifteen years after the Affordable Care Act was enacted, Republicans are still united in criticizing the law but divided on how to proceed. I could feel the tension sharp focus meanwhile government shutdown As Democrats take advantage of rising insurance premiums, put pressure on the republican party He moved to extend expired subsidies for the law often referred to as Obamacare.
President Donald Trump and Republican leaders have said they will consider extending expanded tax credits that are set to expire at the end of the year, but only after Democrats vote to reopen the government. Meanwhile, people enrolled in the plan have already been notified of a significant increase in premiums for 2026.
City Hall is filled with disaffected voters, and there are no clear Republicans. A plan emergesthe problem seems to be gain political power In preparation for next year’s midterm elections.
“Regardless of whether it’s extended or not, premiums are going to go up,” Republican Sen. Rick Scott said. “Premiums are going up because health care costs are going up. Because Obamacare is a disaster.”
“Planning concept”
The shutdown, now in its fourth week with no end in sight, is centered on Democrats’ demands to extend the Affordable Care Act subsidies passed in 2021.
Trump has long promised an alternative. “Obamacare’s costs are out of control and health care is bad,” he wrote in Truth Social in November 2023, adding that he was “seriously considering alternatives.”
When asked about health insurance during a presidential debate in September 2024, President Trump said, “I have an idea for a plan.”
However, nearly 10 months after taking office, that plan has yet to materialize. Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, told NBC on Wednesday that he “fully believes the president has a plan,” but did not elaborate.
Republicans say they want a broad overhaul of the health care system, but it will be difficult to advance such a plan before next year. Party leaders have not outlined how they will handle the expiring tax credits and have insisted they will not negotiate on the issue until Democrats agree to end the government shutdown.
An analysis released in September by the nonpartisan Congressional Budget Office estimated that permanently extending the tax credit would increase the budget deficit by $350 billion from 2026 to 2035. If the tax credit is maintained, the number of people enrolled in health insurance will increase by 3.8 million people in 2035, CBO predicted.
House Speaker Mike Johnson said Wednesday on CNN that Republicans have a “proposal” that will be “ready to go” when asked if they plan to work on subsidies once the government reopens.
“This is a very complex, very complex issue and it will take a long time to build consensus,” he said.
growing political problems
Along with the announcement, premium spikes Now in the mailboxes, political pressure is evident in Republican city halls as the Affordable Care Act health insurance open enrollment period begins Nov. 1.
In Idaho, Rep. Russ Fulcher told a concerned caller that “government-provided health care is the wrong way to go” and “private health care is the right way.” In Texas, freshman Rep. Brandon Gill told a caller facing a significant increase in insurance premiums that Republicans are focused on reducing waste, fraud and abuse.
Harris echoed a message shared by many of her party members at Maryland City Hall, saying costs are “just going back to where they were before COVID-19.”
However, the number of people relying on Affordable Care Act health insurance has significantly increased compared to before the pandemic. More than 24 million people will be enrolled in marketplace plans in 2025, up from about 11 million in 2020, according to an analysis by the healthcare research nonprofit KFF.
Sarah, who lives in Middleville, Michigan, told U.S. Rep. John Moolener at City Hall that if health insurance premiums were raised by 75%, most people would probably no longer have access to health care. “So how do you deal with it?” she asked.
“We have time to negotiate and plan for the future, and I think it can happen,” Moolenaar, who represents the constituency he won in a landslide last year, responded.
Some Republican lawmakers are expressing genuine concerns. A group of 13 House Republicans in the battleground district wrote in a letter to Johnson that the party must “immediately turn its focus to the growing crisis of health care affordability” once the shutdown ends.
“We did not create this crisis, but we now have a responsibility and an opportunity to address it,” the lawmakers wrote.
Some Republican lawmakers have dismissed predictions that ACA premiums would more than double without the subsidies, saying they are exaggerated and that the law encourages fraud and abuse that should be curbed.
Many Democrats credit the Republican effort to repeal Obamacare for flipping the House in 2018 during President Trump’s first term, and expect a similar outcome this time around.
About 4 in 10 U.S. adults say they trust Democrats to do a better job on health care, compared to about a quarter who trust Republicans more. Recent AP-NORC polls Found it. Polls show that about a quarter of people don’t trust either party, and about one in 10 say they trust both parties equally.
The looming conflict within the Republican Party
Republican leaders have promised to discuss ending the subsidies when the government takes office, but it’s clear many Republicans are adamantly opposed to extending them.
“There’s a growing sense, at least among Republicans, that just maintaining the status quo is extremely destructive,” said Brian Blades, president of the Paragon Health Institute and a former health policy adviser during President Trump’s first term.
Michael Cannon, director of health policy research at the libertarian Cato Institute, said he is working with multiple congressional offices on alternatives to ending the subsidies. For example, he wants to expand the Affordable Care Act exemption granted to U.S. territories to all 50 states and reintroduce President Trump’s first-term policy that gave Americans access to short-term health insurance plans outside of the Affordable Care Act.
Cannon declined to name the cooperating lawmakers, but said he hoped they would act on his ideas “quickly.”
David McIntosh, president of the influential conservative group Club for Growth, told reporters Thursday that his group “urged Republicans not to extend coronavirus-era subsidies.”
“We have big spending problems,” McIntosh said.
“I think most people would say, ‘Okay, we’ve had some tough times during COVID,'” he said. “But now that we are back to business as usual, we need to pay our medical bills.”
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Swenson reported from New York.
