By JOEY CAPPELLETTI and ALI SWENSON, Associated Press
WASHINGTON (AP) — The first caller to a telephone town hall with Maryland Rep. Andy Harris, leader of the House’s conservative Freedom Caucus, came ready with a question about the Affordable Care Act. Her cousin’s disabled son is at risk of losing the insurance he has taken out under that lawthe caller said.
“Now she’s looking at two or three times the premium she paid for the insurance,” said the woman, identified as Lisa from Harford County, Maryland. “I’d like you to explain what the Republicans’ plan is for health insurance?”
Harris, a seven-term Republican, had no clear answer. “We think the solution is to try to do something to make sure all the premiums go down,” he said, predicting that Congress would “probably negotiate some kind of off-ramp” later.
His uncertainty reflected a familiar Republican dilemma: Fifteen years after the Affordable Care Act was enacted, the party remains united in criticizing the law but divided on how to move forward. That tension has arisen sharp focus during the government shutdown while Democrats seize on rising premiums Putting pressure on Republicans in extending expiring subsidies for the law, also known as Obamacare.
President Donald Trump and Republican Party leaders say they will consider extending enhanced tax credits that would otherwise expire at the end of the year — but only after Democrats vote to reopen the government. In the meantime, people who participate in the schemes are already receiving notice of significant premium increases for 2026.
While the town halls fill with frustrated voters and no clear Republican plan emergesseems to be the problem gain political strength heading into next year’s midterm elections.
“Premiums are going to go up whether this is extended or not,” said Republican Senator Rick Scott. “Premiums are going up because health care costs are going up. Because Obamacare is a disaster.”
‘Concepts of a plan’
At the heart of the shutdown – which is now in its fourth week with no end in sight – is the Democratic demand that the Affordable Care Act subsidies passed in 2021 be extended.
Trump has long promised an alternative. “The costs of Obamacare are out of control, and besides, it’s not good health care,” he wrote on Truth Social in November 2023. “I am seriously looking at alternatives.”
Pressed about health care during a presidential debate in September 2024, Trump said he had “concepts for a plan.”
But now that he has been president for almost ten months, that plan has yet to materialize. Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, told NBC on Wednesday, “I fully believe the president has a plan,” but did not elaborate.
Republicans say they want a broader overhaul of the health care system, though such a plan would be difficult to achieve before next year. Party leaders have not outlined how they will handle the expiring tax credits, stressing that they will not negotiate on the issue until Democrats agree to end the shutdown.
A September analysis from the nonpartisan Congressional Budget Office estimated that permanently extending the tax credits would increase the deficit by $350 billion between 2026 and 2035. The number of people with health insurance would increase by 3.8 million by 2035 if tax credits were maintained, the CBO predicted.
House Speaker Mike Johnson told a news conference Monday that the tax credits “subsidize bad policies.” Republicans “have a long list of ideas” to tackle health care costs, he said, and are “taking the best ideas we’ve had for years and putting them on paper and making them work.”
“We believe in the private sector and the free market and individual providers,” he added.
A growing political problem
With announcements from premium peaks As it hits mailboxes and the open enrollment period for Affordable Care Act health care plans begins on November 1, the political pressure is clearly present in Republican town halls.
In Idaho, Representative Russ Fulcher told concerned callers that “government-provided health care is the wrong way” and that “private health care is the right way.” In Texas, freshman Rep. Brandon Gill responded to a caller facing a steep premium increase by saying Republicans are focused on reducing waste, fraud and abuse.
Harris reiterated a message shared by many in his party during his town hall in Maryland, saying costs are “just going back to what it was before COVID.”
But the number of people relying on Affordable Care Act health insurance has increased significantly since before the pandemic. More than 24 million people enrolled in market plans in 2025, up from about 11 million in 2020, according to an analysis by healthcare research organization KFF.
Sara from Middleville, Michigan, told Rep. John Moolenaar during his town hall that if health insurance premiums increase by as much as 75%, most people will likely go without health care. “So, how do you go about that?” she asked.
Moolenaar, who represents a district he won handily last year, responded: “We have time to negotiate, work out a plan for the future and I think that’s something that could happen.”
Some Republicans have expressed pressing concerns. In a letter to Johnson, a group of 13 Republicans in the House of Representatives wrote that the party must “immediately turn our attention to the growing health care affordability crisis” once the shutdown ends.
“While we did not cause this crisis, we now have both the responsibility and the opportunity to address it,” the lawmakers wrote.
Some Republicans reject projections that ACA premiums will more than double without the subsidies. They call this exaggerated and say the law has fueled fraud and abuse that must be curbed.
Many Democrats have attributed their ability to flip the House of Representatives in 2018 during Trump’s first term to the Republican Party’s attempt to repeal Obamacare, and they predict a similar outcome this time.
About four-in-ten American adults say they trust Democrats to do a better job of providing their health care, compared with about a quarter who trust Republicans more. recent AP-NORC poll found. According to the poll, about a quarter don’t trust either party, and about 1 in 10 trust both parties equally.
A looming internal GOP fight
Even as Republican leaders promise to talk about ending the subsidies when the government opens, it’s clear that many Republican lawmakers are adamantly opposed to an extension.
“There is a growing sense, at least among Republicans, that maintaining the status quo is deeply destructive,” said Brian Blase, the president of the Paragon Health Institute and a former health policy adviser to Trump during his first term.
Michael Cannon, director of health policy studies at the libertarian Cato Institute, said he is working with multiple congressional offices on alternatives that could end the subsidies. For example, he wants to expand the Affordable Care Act waiver granted to U.S. territories to all fifty states and reintroduce a first-term Trump policy that gave Americans access to short-term health insurance outside the Affordable Care Act marketplace.
Cannon declined to name the lawmakers he worked with, but said he hopes they will act on his ideas “sooner rather than later.”
David McIntosh, president of the influential conservative group Club For Growth, told reporters Thursday that the group has “urged Republicans not to extend those COVID-era subsidies.”
“We have a major spending problem,” McIntosh said.
“I think most people will say, OK, I’ve had a lot during COVID,” he said. “But now it’s back to business as usual and I would have to pay for healthcare.”
Swenson reported from New York.
Originally published:
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