During the government shutdown, Republicans refused to negotiate with Democrats over the enhanced Affordable Care Act subsidies. Though the subsidies expire at the end of the year, Republicans insisted that the issue could wait until after the shutdown. Now the shutdown is long over, the GOP’s health care homework is due, and they’re panicking.
While Democrats did not secure an extension, their intense focus on ACA subsidies highlighted the fact that when they expire, premiums for tens of millions of people are going to skyrocket. Not only that, but health care premiums are rising even for those who get their insurance from their employer. But even as insurers notify Americans of looming premium hikes, the president is proposing and withdrawing multiple plans, and Republicans in Congress are still holding hearings on the topic.
In the crunch moment, the administration and its supporters are scrambling.
Long before the shutdown, Republican pollsters warned that letting the subsidies expire would be a hammer blow to the GOP’s chances in next fall’s midterms. But while Republicans from swing districts are rightfully fearful of voter backlash, many other GOP lawmakers loathe the enhanced ACA subsidies. Trapped between conservative philosophy and political reality, the GOP would rather talk about almost any other issue.
We’ve been here many times before. At the beginning of Trump’s first term, Republicans realized they had to follow through on their promises to “repeal and replace” the ACA. As efforts to create a replacement dragged on, Trump claimed, “Nobody knew health care could be so complicated.” When Republicans eventually cobbled together some legislation, they held no hearings on it, and tried to jam it through Congress. When John McCain provided the final “No” vote with a dramatic thumbs-down, more than a few in the GOP were relieved, since they knew the upheaval their slapdash plan would have caused.
And here we are again. As in 2017, Trump spent the previous year’s presidential campaign promising something better than Obamacare, without specifying what it would be. Now, in the crunch moment, the administration and its supporters are scrambling.
First, Trump proposed sending money to Americans instead of giving subsidies to insurance companies, then said he wanted us all to “feel like entrepreneurs” when we’re “able to go out and negotiate their own health insurance.” To anyone who has had to fight with an insurance company to get their care covered, that sounds less like an exciting opportunity and more like a nightmare.
Then the White House came up with an idea to extend the ACA subsidies for two years, but tighten eligibility and require everyone to pay something (many lower-income enrollees previously wound up with zero premiums after subsidies). In addition, the plan would boost health savings accounts and encourage people to downgrade to policies with higher deductibles. That plan, first reported by MS NOW’s Jake Traylor, was supposed to be announced Monday.
The truth is that conservatives just don’t think it ought to be the government’s job to provide health care — even though today, the U.S. government gives health care to more people than ever.
But it was too much for many congressional Republicans, who weren’t consulted in the plan’s formulation. “I wasn’t expecting the proposal to be Obamacare-lite,” one GOP lawmaker told MS NOW. “Absolutely not supportive of extending ACA subsidies.” Faced with a revolt, the White House postponed the formal announcement and is now scrambling to figure out what to do. “I’d rather not extend [the subsidies] at all,” Trump said Tuesday, and yet “some kind of extension might be necessary to get something done.”
The truth is that conservatives just don’t think it ought to be the government’s job to provide health care — even though today, the U.S. government gives health care to more people than ever. Add together Medicare, Medicaid and the TRICARE system for the military and veterans, and more than 150 million Americans, or nearly half the country, enjoy government health insurance.
Conservatives would much rather the private sector handle the provision of health insurance, and their preference is always for the government to do less. Witness the deep Medicaid cuts that were included in their Big Beautiful Bill, which would lead millions of Americans to lose coverage. Republicans may have made their peace with not going after Medicare – which seniors will defend furiously – but they’ll try to cut and privatize everywhere they can, especially Medicaid and the ACA.
Yet Americans want the government to help them with health insurance. Medicare, Medicaid, and the ACA are all extremely popular. These premium increases are coming at a moment when the public is already worried about affording the necessities of life. Not only that, but health care is an issue where voters’ default assumption is that Democrats want to give them more and Republicans want to give them less — an assumption that was only reinforced by the shutdown.
That puts Republicans in a quandary: They’d love to change the subject, but people are incredibly anxious about the cost of their health care.
Trump clearly understands that the pressure is building for him and his party to do something. But he may have an unsolvable problem on his hands. During the shutdown, Republicans got what they wanted – and now they’re reaping the consequences.
Paul Waldman is a journalist and author focused on politics and culture.