GOP Face Health Care Voter Frustrations10/28 06:12

   

   WASHINGTON (AP) -- The first caller on 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 gained under that law, the caller said.

   "Now she's looking at two or three times the premium that she's been paying 
for the insurance," said the woman, identified as Lisa from Harford County, 
Maryland. "I'd love for you to elucidate what the Republicans' plan is for 
health insurance?"

   Harris, a seven-term Republican, didn't have a clear answer. "We think the 
solution is to try to do something to make sure all the premiums go down," he 
said, predicting Congress would "probably negotiate some 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 come into sharp 
focus during the government shutdown as Democrats seize on rising premiums to 
pressure Republicans into extending expiring subsidies for the law, often 
referred to as Obamacare.

   President Donald Trump and GOP leaders say they'll consider extending the 
enhanced tax credits that otherwise expire at year's end -- but only after 
Democrats vote to reopen the government. In the meantime, people enrolled in 
the plans are already being notified of hefty premium increases for 2026.

   As town halls fill with frustrated voters and no clear Republican plan 
emerges, the issue appears to be gaining political strength heading into next 
year's midterm elections.

   "Premiums are going up whether it gets extended or not," said GOP Sen. Rick 
Scott. "Premiums are going up because health care costs are going up. Because 
Obamacare is a disaster."

   'Concepts of a plan'

   At the center of the shutdown -- now in its fourth week with no end in sight 
-- is a Democratic demand that Affordable Care Act subsidies passed in 2021 be 
extended.

   Trump has long promised an alternative. "The cost of Obamacare is out of 
control, plus, it's not good Healthcare," he wrote on Truth Social in November 
2023. "I'm seriously looking at alternatives."

   Pressed on health care during a September 2024 presidential debate, Trump 
said he had "concepts of a plan."

   But nearly 10 months into his presidency, that plan has yet to come. 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 didn't 
go into details.

   Republicans say they want a broader overhaul of the health care system, 
though such a plan would be difficult to advance before next year. Party 
leaders have not outlined how they'll handle the expiring tax credits, 
insisting they won't 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 from 2026 to 2035. The number of people with health insurance 
would rise by 3.8 million in 2035 if the credits are kept, CBO projected.

   House Speaker Mike Johnson told a press conference Monday that the tax 
credits are "subsidizing bad policy." Republicans "have a long list of ideas" 
to address health care costs, he said, and are "grabbing the best ideas that 
we've had for years to put it on paper and make it work."

   "We believe in the private sector and the free market and individual 
providers," he added.

   A growing political issue

   With notices of premium spikes landing in mailboxes now and the open 
enrollment period for Affordable Care Act health plans beginning Nov. 1, the 
political pressure has been evident in Republican town halls.

   In Idaho, Rep. Russ Fulcher told concerned callers that "government provided 
health care is the wrong path" and that "private health care is the right 
path." In Texas, freshman Rep. Brandon Gill responded to a caller facing a 
sharp premium increase by saying Republicans are focused on cutting waste, 
fraud and abuse.

   Harris echoed a message shared by many in his party during his Maryland town 
hall, saying costs are "just going back to what it was like before COVID."

   But the number of people who rely on Affordable Care Act health insurance 
has increased markedly since before the pandemic. More than 24 million people 
were enrolled in the marketplace plans in 2025, up from about 11 million in 
2020, according to an analysis from the health care research nonprofit KFF.

   Sara from Middleville, Michigan, told Rep. John Moolenaar during his town 
hall that if health insurance premiums go up by as much as 75%, most people 
will probably go without health care. "So how do you address that?" she asked.

   Moolenaar, who represents a district he handily won last year, responded: 
"We have time to negotiate, figure out a plan going forward and I think that's 
something that could occur."

   Some Republicans have shown urgent concern. In a letter sent to Johnson, a 
group of 13 battleground House Republicans wrote that the party must 
"immediately turn our focus to the growing crisis of health care affordability" 
once the shutdown ends.

   "While we did not create this crisis, we now have both the responsibility 
and the opportunity to address it," the lawmakers wrote.

   Some Republicans dismiss projections that ACA premiums will more than double 
without the subsidies, calling them exaggerated and arguing the law has fueled 
fraud and abuse that must be curbed.

   Many Democrats credited their ability to flip the House in 2018 during 
Trump's first term to the GOP's attempt at repealing Obamacare, and they're 
forecasting a similar outcome this time.

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

   A looming internal GOP fight

   Even as GOP leaders pledge to discuss ending the subsidies when the 
government opens, it's clear that many Republican lawmakers are adamantly 
opposed to an extension.

   "At least among Republicans, there's a growing sense that just maintaining 
the status quo is very destructive," said Brian Blase, the president of 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's working with multiple congressional offices on 
alternatives that would let the subsidies end. For example, he wants to expand 
the Affordable Care Act exemption given to U.S. territories to all 50 states 
and reintroduce a first-term Trump policy that gave Americans access to 
short-term health insurance plans outside the Affordable Care Act marketplace.

   Cannon declined to name the lawmakers he's working with, but said he hopes 
they act on his ideas "sooner than later."

   David McIntosh, president of the influential conservative group Club For 
Growth, told reporters Thursday that the group has "urged the Republicans not 
to extend those COVID-era subsidies."

   "We have a big spending problem," McIntosh said.

   "I think most people are going to say, OK, I had a great deal during COVID," 
he said. "But now it's back to business as usual, and I should be paying for 
health care."