Fifteen years after its passage, the Affordable Care Act found itself at the center of the longest federal government shutdown in American history. The government is open again, but Republicans — who control the House, Senate and White House — are railing against the current system.
“We know that American health care needs dramatic reform,” House Speaker Mike Johnson, R-La., said at a news conference last month. “Let’s just state it simply: Obamacare failed the American people.”
The Affordable Care Act, which was passed during President Barack Obama’s administration, is colloquially known as “Obamacare.”
“Obamacare is causing premiums to skyrocket,” Sen. Ron Johnson, R-Wis., said on the Senate floor last month.
“The biggest lie in town is the Affordable Care Act. It’s the Unaffordable Care Act,” Sen. Lindsey Graham, R-S.C., joked to reporters.
“Obamacare, which is terrible, it’s not been good, as you know. It’s a weak form of health care,” President Donald Trump said in the Oval office the day before the shutdown began.
During the pandemic, Congress created an enhanced subsidy for certain people enrolled in health insurance through the Affordable Care Act. The tax credit, which lowers enrollees’ monthly premiums, is set to expire at the end of this year. But those subsidies are needed in the first place, in part because health care costs are rising.
KFF, a nonpartisan health policy research nonprofit, says about 4 in 10 adults worry about affording their monthly health insurance premiums.
“A health care cost per person in this country is twice that of other developed nations,” Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz said at a congressional hearing earlier this year. “Why is it costing us so much? Because of chronic disease.”
Chronic disease is one of the top three factors that Johns Hopkins Bloomberg School of Public Health professor Gerard Anderson said is contributing to rising costs.
“The underlying reasons why health insurance costs are increasing is that the health care system is becoming more expensive,” Anderson said.
In addition to the rise in chronic disease, Anderson points to rising drug costs — both prescription drugs and increasingly popular GLP-1 weight loss medications — as well as the high cost of physician and hospital expenses as top contributors.
Many Republicans, including Speaker Johnson, say the health care system is in need of reform. Johnson said earlier this week, “We got a lot of work to do on that.”
Anderson said the proposal to reform the ACA by having Americans put money into a personal health savings account is “unreasonable.” But the Democratic approach, which includes extending the enhanced subsidies, faces an uphill battle.
“The Affordable Care Act, was it perfect? Absolutely not,” former CMS Administrator Chiquita Brooks-LaSure admitted. “We all know that we have things to work on for our health care system, but cutting people off, our middle class workers, is not the way to go about it.”
Brooks-LaSure emphasized that the subsidies have been crucial for maintaining affordability. She said many may have forgotten what it was like before the ACA was passed, a point echoed by Cynthia Cox, a KFF vice president and director of the program on the ACA.
“It was really like the Wild West out there,” Cox said.
But the legislative path forward remains unclear. Senate Majority Leader John Thune, R-S.D., has promised to bring a vote on extending ACA enhanced subsidies to the Senate floor in December. Meanwhile, Speaker Johnson has not committed to hold a vote in the lower chamber.
“The path forward is just not looking very clear,” Cox said. “I think it’s more likely that the enhanced tax credits will expire at the end of the year.”
