Republicans Will Never Find a Health Care Replacement, The American Prospect, November 18, 2025, by Ryan Cooper
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 âbrainstorming sessionsâ about what to do, and House Speaker Mike Johnson claims that they will âbe rolling out some of those ideasâ at some point.
So far, the genius idea in the lead is Trumpâs 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 wouldnât then just use that money to buy health insurance, Trump replied, âAhh ⊠some may. I mean, theyâll be negotiating prices.â 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, Iâm sure youâll 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 donât have a âhealth care planâ 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. âŠ
But itâs 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. âŠ
Their replacement âideasâ consist of either shifting the [ACA premium] subsidies to people, who will then find out that theyâll 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.
Panic Tears Through U.S. as Health Insurance Costs Spike, The American Prospect, November 21, 2025, by Whitney Curry Wimbish
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 âbenchmarkâ 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, theyâre 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 yearâs 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 âan outrageous amount.â Not anymore.
At one point, Rowan seriously contemplated dropping health insurance completely, he said. âBut the fear of something unexpected happening and my moderate savings being wiped out is forcing me to pay the piper. Itâs a completely fear-based decision.â âŠ
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 ânegotiate pricesâ with health care companies. Fellow Prospect-er Ryan Cooper notes that this wonât 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 theyâre 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 ârisk pool.â 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 doesnât just stay there. Because major insurance companies are the ones providing the ACA coverage, this means one way theyâll make up the loss caused by the worse risk pool is by raising premiums on their clients who get their insurance through their employer. âŠ
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 âshort-termâ or âjunkâ 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.
Comment:
By Jim Kahn, M.D., M.P.H.
Two articles in âThe American Prospectâ 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 â including in the MAGA base â are harshly affected, and know where to cast the blame.
Taking away something good â i.e., ratcheting back health insurance â 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 whatâs going on and how itâs 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) â public, universal health insurance that is simple, generous, equitable, efficient, and health-enhancing. Single payer.
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