WASHINGTON (AP) — The first caller in a conference call with Maryland Rep. Andy Harris, chairman of the conservative House Freedom Caucus, asked a question about the Affordable Care Act. Her cousin’s disabled son is at risk of losing the insurance he received under that law, the caller said.
“Now she’s looking at two or three times the premium she paid for insurance,” said the woman, identified as Lisa of Harford County, Maryland. “I would be interested if you would explain the Republican plan for health insurance?”
Harris, a seven-term Republican, had no clear answer. “We believe the solution is to do something to ensure that all premiums go down,” he said, predicting that Congress would later “probably negotiate a way out.”
His uncertainty reflected a familiar Republican dilemma: Fifteen years after the Affordable Care Act was passed, the party remains united in its criticism of the law but divided over how to move forward. That tension has become clear during the government shutdown, as Democrats have exploited rising premiums to pressure Republicans to extend expiring subsidies for the law often referred to as Obamacare.
President Donald Trump and Republican leaders say they will consider extending expanded tax credits that would otherwise expire at the end of the year – but only after Democrats vote to reopen the government. In the meantime, tariff participants have already been informed of significant premium increases for 2026.
As town halls fill with frustrated voters and no clear Republican plan emerges, the issue appears to be gaining political traction ahead of next year’s midterm elections.
“Premiums are going up whether they are renewed 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 heart of the shutdown — now in its fourth week with no end in sight — is Democrats’ demand to extend the Affordable Care Act subsidies passed in 2021.
Trump has long promised an alternative. “The cost of Obamacare is out of control, plus it’s not good health care,” he wrote on Truth Social in November 2023. “I’m seriously looking for alternatives.”
Trump was pressed on health care during a presidential debate in September 2024, saying he had “concepts for a plan.”
But nearly 10 months into his presidency, that plan is still pending. Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, told NBC on Wednesday, “I firmly believe the president has a plan,” but did not go into details.
Republicans say they want a broader overhaul of the health care system, although such a plan may be challenging to advance before next year. Party leaders have not spelled out how they will handle the expiring tax credits and insist they will not negotiate the issue until Democrats agree to end the shutdown.
A September analysis by the nonpartisan Congressional Budget Office estimated that a constant expansion of tax credits would add $350 billion to the deficit from 2026 to 2035. The number of people with health insurance would boost by 3.8 million in 2035 if the tax credits were maintained, CBO predicted.
Asked on CNN Wednesday whether Republicans had a plan to address subsidies if the government reopened, House Speaker Mike Johnson said they had “proposals” that could be “ready immediately.”
“It is a very complicated and complex issue that will take a long time to reach consensus,” he said.
A growing political issue
With reports of increased premiums now hitting mailboxes and the open enrollment period for health insurance under the Affordable Care Act beginning Nov. 1, the political pressure in Republican town halls has become clear.
In Idaho, Rep. Russ Fulcher told concerned callers that “public health care is the wrong way” and “private health care is the right way.” In Texas, freshman Rep. Brandon Gill responded to a caller facing a dramatic premium hike and said Republicans were focused on reducing waste, fraud and abuse.
Harris reiterated a message shared by many in his party during his Maryland town hall visit, saying costs are “simply going back to pre-COVID levels.”
But the number of people relying on health insurance under the Affordable Care Act has increased significantly since before the pandemic. More than 24 million people were enrolled in marketplace plans in 2025, up from about 11 million in 2020, according to an analysis by nonprofit health research organization KFF.
Sara, of Middleville, Michigan, told Rep. John Moolenaar during his town hall meeting that if health insurance premiums increased by up to 75%, most people would likely go without health care. “So how do you deal with this?” she asked.
Moolenaar, who represents a district he won handily last year, responded: “We have time to negotiate and come up with a plan for the future, and I think that could happen.”
Some Republicans expressed grave concern. In a letter to Johnson, a group of 13 embattled House Republicans wrote that the party must “immediately shift our focus to the growing health care affordability crisis” once the shutdown ends.
“Although we did not cause this crisis, we now have both the responsibility and the opportunity to address it,” the lawmakers wrote.
Some Republicans reject predictions that ACA premiums would more than double without the subsidies, calling them exaggerated and arguing the law has fueled fraud and abuse that must be curbed.
Many Democrats attributed their ability to flip the House in 2018 during Trump’s first term to the GOP’s attempt to repeal Obamacare, and they predict a similar outcome this time.
About four in 10 U.S. adults say they trust Democrats to do a better job on health care, compared with about a quarter who trust Republicans more, a recent AP-NORC poll found. According to the survey, about a quarter trust neither party, and about one in 10 trust both equally.
A looming internal GOP battle
Even as GOP leaders promise to discuss ending the subsidies when the administration takes office, it is clear that many Republican lawmakers strongly oppose an extension.
“There is a growing sense, at least among Republicans, that simply maintaining the status quo is very destructive,” said Brian Blase, 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 several congressional offices on alternatives that would allow an end to the subsidies. For example, he wants to expand the Affordable Care Act’s exemption for U.S. territories to all 50 states and reinstate a first-term Trump policy that gives Americans access to short-term health insurance plans outside of the Affordable Care Act’s marketplace.
Cannon declined to name the lawmakers he is working with, but said he hopes they will 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 Republicans not to extend these COVID-era subsidies.”
“We have a big spending problem,” McIntosh said.
“I think most people will say, OK, I’ve had a lot during the COVID-19 crisis,” he said. “But now everything is back to normal and I should pay for healthcare.”
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Swenson reported from New York.
