The following is the opinion and analysis of the writer:
Thomas O’Rourke
The current healthcare debate over extending health care insurance subsidies for millions, resulting in the longest government shutdown, remains unresolved. Both political parties remain intransigent, leaving millions of Americans facing a Hobson’s choice of a doubling, tripling, quadrupling of monthly premiums, or purchase a huge deductible cost-sharing plan, a stripped-down bare benefit plan or risk being uninsured.
On average, more than 20 million subsidized enrollees in the Affordable Care Act program are seeing their premium costs rise by 114% in 2026. Representative Marjorie Taylor Greene, the right-wing Republican from Georgia, wrote on X that she was “disgusted” that premiums for her adult children would double without action.
At the heart of the dispute is extending subsidies helping people buy health insurance under the Affordable Care Act, enacted in 2010. In 2021, during COVID, Democrats made the subsidies more generous, resulting in a doubling of Affordable Care Act enrollment, especially in red states of Florida, Texas and Georgia.
With the enhanced subsidies expiring in 2025, Democrats supported an extension to prevent millions from losing coverage due to health care insurance becoming unaffordable. Republicans opposed, arguing that extending subsidies would be expensive, citing the Congressional Budget Office estimating a cost of about $350 billion over the next decade. Extending subsidies also does nothing to address the more important issue of rising health care costs. It just shifts more costs to the federal government. Critics also expressed concern that generous pandemic-era subsidies have resulted in instances of fraud and abuse, although the magnitude of the problem is highly disputed and unknown.
The stalemate is summed up well by the lyrics from one of the most widely known protest songs of the 1960s For What It’s Worth by Buffalo Springfield, “There’s battle lines being drawn and nobody’s right if everybody’s wrong.” Both parties are wrong. Amidst the stalemate, neither party addresses the most important problem of health care costs. The US spent $13 432 per person on health care in 2023, which is more than 80% higher than the $7393 per-person average in other high-income countries. For family coverage, the total annual premium in 2025 was $26 993. For that amount a person one could buy a new Toyota Corolla Hybrid every year for less than a family health insurance premium. From another perspective, median weekly earnings for full-time workers was $1,196 in the second quarter of 2025, or about $62 ,000 on an annual basis. That translates into a family health insurance premium of over 40% of the typical salary.
Health insurance is different for other insurance such as home or auto. While necessary, its unpredictability and costs can make it unaffordable to almost anyone, regardless of income. No doubt, because of low income, subsidies or cost shifting will always be needed for people, working or not, able-bodied or not or for millions of others facing high health care needs beyond their means. The only way to achieve health care affordability is lowering health care costs. Difficult yes. Impossible not. Every other industrial nation, using different models, has achieved this while making care universally accessible along with better outcomes. The last thing needed is to throw more money at the problem or leave people facing unaffordable coverage. Lowering costs and ensuring accessibility, not arguing enhanced subsidies, should be the focus of health care reform debate.
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