Republicans Will Never Find a Health Care Replacement, The American Prospect, November 18, 2025, by Ryan Cooper

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Republicans, for once, are sounding downright squeamish about onrushing massive cuts to Obamacare subsidies, with premiums on the exchanges expected to more than double on average starting next year. GOP House committee chairs are reportedly having some “brainstorming sessions” about what to do, and House Speaker Mike Johnson claims that they will “be rolling out some of those ideas” at some point.

So far, the genius idea in the lead is Trump’s pitch to reroute subsidies from health insurance companies to the American people, so they can buy health care. (House Republicans have already filed a bill that looks like this.) When asked whether people wouldn’t then just use that money to buy health insurance, Trump replied, “Ahh … some may. I mean, they’ll be negotiating prices.” Congratulations, folks, you now get to be your own private dealmaker with the health care system, and with your purchasing power and risk pool of one household, I’m sure you’ll get the best price!

The stupidity is the point. For decades now, the Republican Party has been dedicated to the proposition that rich people are too highly taxed and the working and middle classes get too many benefits from the government. With the passage of the One Big Beautiful Bill, they have finally caught the car. Medicaid and Obamacare have been slashed to free up budget headroom for tax cuts heavily slanted to the wealthy. Republicans don’t have a “health care plan” per se because this is their plan: to take your health care funding and give it to Elon Musk, Donald Trump, and the rest of the fascist billionaire class. …

But it’s a much more practical problem for a Republican trying to write a health care policy. Health insurance is straightforwardly impossible to square with capitalist morality for reasons a child can understand. Most obviously, people routinely get very sick or injured through no fault of their own, and require care that is far more expensive than they can afford out of pocket. Sometimes people have chronic conditions that cost many multiples of what they could ever possibly earn. Therefore, unlike the market for car or home insurance, where each person is charged exactly what they are statistically expected to claim (plus a margin of profit), any functioning health insurance scheme must have systematic transfers from the young and healthy to the elderly and sick. …

Their replacement “ideas” consist of either shifting the [ACA premium] subsidies to people, who will then find out that they’ll have to use the money to buy health insurance. As some Freedom Caucus members recently floated, that could translate into pre-Obamacare fake insurance, which does nothing for people when care is actually needed.

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Panic Tears Through U.S. as Health Insurance Costs Spike, The American Prospect, November 21, 2025, by Whitney Curry Wimbish

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Open enrollment is under way for 2026 insurance coverage, and millions of Americans are facing extreme sticker shock thanks to the end of expanded Affordable Care Act subsidies, which capped Obamacare premiums for a “benchmark” insurance plan at 8.5 percent of income. Twenty-two million people relied on that funding, at a cost of about $35 billion annually.

With the expanded subsidies set to expire at the end of the year, reverting back to a less generous subsidy level last in place in 2021, patients around the country are facing premium increases that are so extreme, they’re either reducing health insurance coverage or dropping it altogether. Some are facing price hikes many multiples higher than they paid last year; those whose costs only doubled told the Prospect they considered themselves lucky by comparison.

A retiree in Colorado, Jeff Rowan, described how this year’s open enrollment is driven by a sense of fear. His 2026 premium for a health plan on the state insurance exchange went from $350 a month to around $900. So he switched to a plan offered by his pension, which is $700, still a 100 percent increase. Last year, Rowan concluded that was “an outrageous amount.” Not anymore.

At one point, Rowan seriously contemplated dropping health insurance completely, he said. “But the fear of something unexpected happening and my moderate savings being wiped out is forcing me to pay the piper. It’s a completely fear-based decision.” …

Republican lawmakers are reportedly coming up with a fix, such as giving people money directly via flexible savings accounts or health savings accounts, which they would then use to “negotiate prices” with health care companies. Fellow Prospect-er Ryan Cooper notes that this won’t work. Even Trump himself acknowledged that most people would send that money right back to insurance companies, the only entities in the economy with the leverage to negotiate with hospitals under the current system.

THE END OF ACA SUBSIDIES WITH NO PLAN IN PLACE means that people who believe they’re healthy will simply not get coverage, said Dr. Vikas Saini, president of the Lown Institute, a nonpartisan think tank focused on the health care system. The remaining population on insurance will be sicker on average, a condition that doctors and economists sometimes refer to as a worse “risk pool.” That makes it costlier for companies to insure the average policyholder. So the result of millions dropping unaffordable health insurance, as the Congressional Budget Office has forecast, will be that insurance subsequently gets more expensive.

What happens on ACA exchanges doesn’t just stay there. Because major insurance companies are the ones providing the ACA coverage, this means one way they’ll make up the loss caused by the worse risk pool is by raising premiums on their clients who get their insurance through their employer. …

Like others navigating the horror show, Sam said the cost-of-living crisis is frightening. He wonders, if Republicans are going to make health care unaffordable, will they also roll back other Democratic policies, like allowing insurance companies to deny coverage because of pre-existing conditions? Indeed, one of the options Republicans are pitching for patients without insurance is enrolling in “short-term” or “junk” insurance plans, which are not required to cover pre-existing conditions. Officials in five states have barred these products. But the Trump administration relaxed the rules governing them in August.

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Comment:

By Jim Kahn, M.D., M.P.H.

Two articles in “The American Prospect” describe vividly how recent federal funding cuts are driving ACA insurance premiums to unaffordable levels and reducing Medicaid coverage for low-income populations. They also highlight the unworkability of GOP ideas to offer a few thousand dollars to individuals to negotiate with insurers for policies that likely will no longer comply with fairness rules instituted by the ACA.

It is, to adopt a slightly profane formulation, a cluster-f*ck. The changes will increase the ranks of the un- and under-insured by tens of millions, and shortchange other critical household needs to scrape up insurance premiums and out-of-pocket costs.

I hate it, for the inhumanity. The silver lining is that many voters – including in the MAGA base – are harshly affected, and know where to cast the blame.

Taking away something good – i.e., ratcheting back health insurance – is easier to recognize than never having received that good in the first place. So, those losing insurance or paying far more for it understand what’s going on and how it’s causing them pain. And they know whom to blame.

And … they will be increasingly open to permanent solutions built on a foundation of (familiar refrain now) – public, universal health insurance that is simple, generous, equitable, efficient, and health-enhancing. Single payer.

https://healthjusticemonitor.org…

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5 ways our health care system has become utterly insane, Your Local Epidemiologist, Nov. 12, 2025, by Katelyn Jetelina & Hayden Rooke-Ley

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To me (KJ), the debate in Washington is far too small. The real story isn’t just whether subsidies stay or go – it’s how completely insane our health care system has become, and whether there will be a serious effort to address underlying costs in the system.

I know juuusssttt enough to get in trouble, so I partnered with the incredible Hayden Rooke-Ley, who is a leading national policy expert in this area, to break down the five ways the entire system has gone off the rails.

1. Costs vs. wages: A 20-year disconnect.

Over the past two decades, the cost of employer-sponsored health insurance has skyrocketed. Premiums, deductibles, and out-of-pocket costs have all soared – far faster than wages. More than half worry they’ll fall into debt any time they use the health care system.  More than 60% of those in medical debt have insurance.

2. We pay the most and get the least.

Outcomes: Despite record spending, Americans live shorter, sicker lives than peers. We underinvest in prevention, such as primary care and social supports like housing and nutrition.

Access: More than 100 million Americans live in a primary-care desert, while almost 60 million live in a pharmacy desert.

Clinician workforce: Health care workers are burning out or leaving the profession altogether.

3. Americans don’t “over consume” health care. Prices and private bloat drive costs.

Americans don’t visit the doctor more, we don’t go to the hospital more, and we don’t stay in the hospital for longer. The real difference is price.

Our system is drowning in private-sector bloat and bureaucracy, more so than any other country. Roughly one in four dollars spent on health insurance goes to something other than care, like marketing, billing, profits or middlemen.

4. Corporate and financial firms have taken over care.

Perhaps the most underappreciated transformation of the past 40 years is the corporate consolidation and financialization of medicine.

Private-equity firms now own everything from nursing homes and hospices, to emergency departments and physician practices. Their model is simple: buy up fragmented practices, cut labor costs, raise prices, and resell for profit.

5. Existing approaches have failed – and the latest proposals are more of the same.

The idea was to embrace more free market principles in health care.

• Private insurers compete for patients: managed competition, pharmacy benefit managers, etc.
• Over-reliance on economic incentives: pushing physicians into value-based care, and patients rationing through higher deductibles
• Commercialization – converting public hospitals to for-profit chains

The current debate recycles the same logic: more private control, higher out-of-pocket costs, and less regulation of prices or profits. The latest idea is that deductibles need to be higher and patients don’t pay enough. … This approach has failed for 40 years. …

Bottom line

The U.S. health care system is uniquely dysfunctional. A different approach is entirely possible – if we have the will to boldly govern the health care system in the interests of patients, clinicians, and taxpayers. That means directly tackling prices, eliminating middlemen, and breaking up behemoths. It also means returning ownership of care delivery to clinicians and communities and pursuing a strategy that builds the workforce and capacity to meet America’s needs.

Health care touches everyone, and we need a system that works for us, not one that makes us work for it.

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Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

Epidemiologists are sophisticated in thinking about the prevalence and spread of disease. However, they don’t understand much about health system financing and function. So this essay is a terrific primer for them. It’s an insightful status check on the unhealthy state of our health system. Impression (a medical term): Imbalanced, with excess money and a care deficit – especially for those short on money. High costs and poor performance make it obvious that we need a transformed approach. Treatment plan: Radical shift from money focus to medical care.

It’s clear what policies are needed — providing access to care for all, while keeping the system affordable overall and for each of us. This will require major shifts in approach. Ownership should be shifted to improve access and affordability for everyone, instead of increasingly guiding profits to the wealthy while impairing access and affordability for those with lower incomes – workers and especially the indigent.

The policies we need seem obvious, so it is consensus and collective action that is needed. We actually mainly share core values. We almost all agree that everyone should have the health care that they need. Likewise, that a financing system should be distributed to ensure that the system is affordable for everyone, even if this means that the very wealthy pay a larger amount (that they would never miss), in order to avoid extracting sums from lower income individuals that are needed to meet their most basic needs.

Step back and think about it. If we worked together, we could meet the goals of accessible, affordable health care for everyone without anyone suffering adverse consequences. We are not asking the wealthy to suffer the pains of poverty.

Hayden Rooke-Ley (this time with Katelyn Jetelina) explains how to get the health system to work in favor of everyone. Isn’t it time that we listened to them, to all of the other advocates for health care justice for all, and indeed to our clear collective values?

https://healthjusticemonitor.org…

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What Americans think about rising health care costs, according to a new AP-NORC poll, Associated Press, Oct. 21, 2025, by Ali Swenson & Linley Sanders

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Most U.S. adults are worried about health care becoming more expensive. About 6 in 10 Americans are “extremely” or “very” concerned about their health costs going up in the next year, the survey from The Associated Press-NORC Center for Public Affairs Research finds.

The poll found that about 4 in 10 Americans are “extremely” or “very” concerned about not being able to pay for health care or medications they need, not being able to access health care when they need it, or losing or not having health insurance. Federal policies have left millions of people at risk of skyrocketing health insurance premiums or of losing their health insurance altogether.

About 8 in 10 U.S. adults say the issue of health care is “extremely” or “very” important to them personally. That includes about 9 in 10 Democrats and three-quarters of Republicans, and it puts health care next to the economy among Americans’ top issue priorities.

President Donald Trump’s mega-bill that passed this summer cuts more than $1 trillion from federal health care and food assistance over a decade. Republicans say the cuts will prevent people who don’t need aid from gaming the system, but the cuts will ultimately result in millions of people losing health insurance coverage, according to projections from the nonpartisan Congressional Budget Office.

In interviews, some Americans said they doubted government leaders would take the necessary action to address their concerns on health care. But the poll reveals a deep ideological divide over what the government’s role should be, with Democrats far more likely than Republicans to say it’s the federal government’s job to make sure all Americans have health coverage. About 8 in 10 Democrats say this, compared with about one-third of Republicans.

About 4 in 10 U.S. adults say they trust Democrats to do a better job handling health care, compared with about one-quarter who trust the Republicans more. About one-quarter trust neither party, and about 1 in 10 trust both equally.

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Comment:

By Don McCanne, M.D.

Let’s see if we can make sense of the attitudes of Americans toward health care costs.

First, probably the most important fact is that 80% of Americans believe that health care is ‘extremely” or “very” important to them personally. This has clear bipartisan support – 90% of Democrats and 75% of Republicans.

Second, 60% of all Americans are concerned about health care costs going up next year, and 40% believe that health care and insurance will be unaffordable or inaccessible.

Across the board, Americans believe that some changes need to be made to assure that health care will be affordable and accessible. But then comes the partisan divide: whether Democrats or Republicans would be more capable of taking the necessary actions to address Americans’ concerns on health care.

Let’s break down the numbers. Fifty percent believe that the Democrats would do a better or at least a competent job in handling health care (40% better, 10% equivalent to Republicans). Thirty-five percent believe that the Republicans would do a better or competent (25% better, 10% equivalent to Dems).

So what have we learned from this poll? People are clearly worried about affordability and accessibility of health care now, and even more for the future. Although a majority of Democrats and a minority of Republicans believe that the Democrats would do a better job in fixing the system, it appears that we should seek solutions that would receive bipartisan support.

We now have many studies that show that a well-designed single payer system could both provide affordable and comprehensive care for everyone, while bridging political differences in reform ideologies. Here’s how:

Single payer design features would automatically include everyone while reducing the profound excess expenditures caused by private insurers and private equity that diverts patient care funds to the entrepreneurial intermediaries that have driven up costs and driven down system performance. These funds would be re-directed to the delivery system for the benefit of patients (and thus reduce moral injury for providers). By eliminating administrative waste and profits for passive investors, we would have sufficient funds to provide care for everyone.

How about the political differences? With preferences for Democratic policies outweighing Republican policies, we could sit down and agree that the taxes used to pay for the system would be progressive, based on the ability to pay. The vast majority of taxpayers – Dem & GOP – would find that those taxes are reasonable. Billionaires might object to the numbers on their tax forms, even though they would see no impact on their lifestyles.

Isn’t it about time that the Republicans, Democrats, and Independents decide to cooperate on striving for a better society for all of us – by sitting down to craft a health care system that would solve our current problems and work well for all of us? Efficient cooperation seems like a much better approach than expensive and inefficient bickering. That’s the wealthy nation standard; let’s get with the program!

https://healthjusticemonitor.org…

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Universal Healthcare Will Save Lives… and Could Save the Democratic Party, Common Dreams, Oct. 22, 2025, by Diljeet K. Singh, MD, DrPH, president of Physicians for a National Health Program

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As the only wealthy country without universal coverage, sticking to our current system is truly not “politically feasible.” Democratic leaders need to understand and embrace America’s desire for change.

The ongoing government shutdown, a standoff over health insurance premiums, is a missed opportunity to truly reform healthcare and revive the Democratic Party.

Democrats have been hyper focused on restoring Medicaid cuts and preserving Affordable Care Act (ACA) subsidies to blunt the harmful healthcare impact of the Republican budget. But this narrow strategy not only fails to address the core issues of the current system but ignores what most Americans want most: a system free from profit-driven conflicts of interest, prior authorizations, co-pays, deductibles, or the threat of bankruptcy. …

Americans want trustworthy, high-quality healthcare without conflicts of interest, co-pays, deductibles, or financial risk. A May 2025 Pew poll confirms this, with 68% of Americans, including 90% of Democrats and 45% of Republicans, believing the government should provide health insurance for all. A November 2024 Gallup poll shows 62% of Americans, including 90% of Democrats, 65% of Independents, and 32% of Republicans, think the federal government should guarantee health coverage for everyone. And a 2024 Marist Poll found 86% of Gen Z and 76% of Millennials also share the opinion that health insurance is the government’s responsibility. …

Meanwhile, Democrats are defending the status quo instead of fighting for the comprehensive health care reform that Americans need. Despite the unpopularity of much of what the Trump administration has done, support for the Democratic Party from its core members remains slim, with historically low voter registration and approval numbers. Championing universal healthcare gives Democrats a chance to move away from the status quo and win back frustrated voters, especially the youth.

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Comment:

By Don McCanne, M.D.

Recently we pointed out that a health policy issue (ACA premium subsidies) is central to the federal budget battle and shutdown. Dems and voters favor retaining the subsidies.

In the above commentary, Dr. Singh – president of PNHP – emphasizes that maintaining a few subsidies isn’t going to cure our health insurance woes or help the Democrats. Instead, what’s needed is universal coverage – i.e., single payer, Medicare for All.

Dr. Singh states that “what most Americans want most: a system free from profit-driven conflicts of interest, prior authorizations, co-pays, deductibles, or the threat of bankruptcy.” And, “Americans from all parties agree that our political and economic systems need change.”

Yet neither major political party has it right in that the Republicans propose changes that would make our system worse, and the Democrats defend the status quo that has been so ineffective.

What both sides should agree on is that a comprehensive system progressively funded based on ability to pay, with billionaires contributing far more healthcare costs than they consume (but leaving them plenty for their extravagant lifestyles).

Bringing health insurance reform to the forefront now is timely with Dr. Singh leading the upcoming national meeting of PNHP, an organization that has long been a leader in the fight for comprehensive, accessible health care for everyone at a price that each of us can afford. She is correct that advocating for guaranteed, high quality, affordable health insurance that would boost the Democrats.

Yet, let’s look more broadly. Since we prefer that reform be based on sound policy rather than divisive politics, can we contemplate joining across parties in supporting health care justice for all, rather than battling ballrooms for billionaires vs. the unpopular status quo? There are plenty of Republicans, Independents, and Democrats who would unify on a government-financed health insurance approach that would guarantee all Americans “trustworthy, high quality health care without conflicts of interest, co-pays, deductibles, or financial risk.”

Let’s do it.

https://healthjusticemonitor.org…

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At Stake in the Shutdown Fight: Obamacare Prices That Could Rise by Thousands of Dollars, The New York Times, Oct. 1, 2025, by Margot Sanger-Katz & Alicia Parlapiano

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Democrats say they will not vote to end the government shutdown unless Congress extends extra Obamacare subsidies that are set to expire next year. Republican leaders have said the subsidies shouldn’t be a part of legislation to reopen the government, though several individual lawmakers are open to the idea.

Should the extra subsidies expire, how much more will people with Obamacare plans pay?

The subsidies, first passed in 2021 and extended in 2022, make health insurance less expensive for nearly all those who buy their own coverage. Since the subsidies’ creation, enrollment in Obamacare markets has more than doubled.

Extending the subsidies would cost the federal government … about $350 billion over the next decade, according to estimates from the Congressional Budget Office. But, without them, many Americans will face much higher costs before the midterm elections next fall — in some cases, increases of more than a thousand dollars per month.

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Despite Budget Concerns, Three-Quarters of Public Say Congress Should Extend the Enhanced ACA Tax Credits Set to Expire Next Year, Including Most Republicans and MAGA Supporters, KFF, Oct. 3, 2025

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7 in 10 Marketplace Enrollees Say They Could Not Afford Coverage if Their Premiums Doubled; 4 in 10 Say They Would Expect to Be Uninsured

More than three-quarters (78%) of the public say they want Congress to extend the enhanced tax credits available to people with low and moderate incomes to make the health coverage purchased through the Affordable Care Act’s Marketplace more affordable, a new KFF Health Tracking Poll finds. That’s more than three times the share (22%) who say they want Congress to let the tax credits expire.

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Comment:

By Jim Kahn, M.D., M.P.H.

For the last two weeks, my focus has been on a major medical issue facing my wife, so HJM has paused. We restart with this post on a health insurance issue currently central to US national politics, and will aim to maintain a steady flow moving forward.

In recent weeks, health insurance has been THE driving issue in the federal government shutdown, which was precipitated by a stalled budget bill for the 2026 fiscal year (started October 1). The sticking point is that the GOP failed to extend COVID-era Affordable Care Act premium subsidies benefiting 13 million individuals. The Democrats in the Senate – whose votes are needed to pass the bill – insist on maintaining the subsidies. They are convinced that highlighting this policy debate will harm the GOP, which appears indifferent to premium jumps of 100% or more. Public opinion polling suggests overwhelming support for extending the subsidies — 92% among Democratic voters and 59% among Republicans. If the budget passes without ACA subsidies, the GOP likely will be blamed for the jump in premiums, which will occur in January 2026 (years before Medicaid cuts passed earlier in 2025), perhaps influencing the 2026 congressional elections.

This is remarkable – a major showdown on federal government subsidies for health insurance. Unlike much of current US politics, it is actually a policy issue: Should the government broadly subsidize health insurance? The message from voters is an adamant “yes.” The GOP seems indifferent; the Dems seem determined.

Is this a pivotal moment where health insurance tips the political scales? It’s too early to say. In the short term, we don’t know who will win the budget bill fight, or what a compromise might look like. And we don’t know how the battle over subsidies will influence the 2026 congressional midterms. Or the 2028 presidential election.

Nonetheless, I’m quite encouraged by the stand that some politicians are taking in favor of broad health insurance, and the public’s extremely supportive reaction.

In an upcoming post, I’ll review how politicians are talking about health insurance. Lots of creative efforts there.

https://healthjusticemonitor.org…

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