Ahead of the 2020 elections, all 20 Democrats presidential candidates promised voters that they would push for bold changes to health care, such as a government-run insurance plan or expanding Medicare to cover every American.
Fast forward to the congressional impasse that shut down the federal government for more than a month. Democrats, entrenched on one side of the legislative battle, have staked their political future on simply preserving parts of the Affordable Care Act, a far cry from the systemic health policy changes that party members once called crucial to addressing the high cost of health care.
Democrats have managed to focus the nation's attention on rising health insurance costs by promising to withhold funding from the federal government until a deal is reached to extend more generous tax subsidies that led to lower premiums for Obamacare plans. Their tenacity could help them win votes in next year's midterm elections.
But prices for medical care are skyrocketing, the number of expensive high-deductible plans is on the rise, and 4 in 10 adults suffer from some form of healthcare debt. As health care costs reach crisis point, there is a yawning chasm between voters' desire for more aggressive action and the political need in Washington for radical change.
“There’s not a lot of enthusiasm among politicians,” he said. Jonathan Grubereconomist who played a key role in the development of the ACA. “Why aren't they being more bold? It's probably the scars from the ACA battles. But health care is a winning issue. The truth is we need universal coverage and price controls.”
Voters rank cutting health care costs as a top priority above housing, jobs, immigration and crime, according to the poll. September poll Hart Research Associates for Families USA, a consumer health advocacy group.
And costs are rising. Work-based health insurance premiums rose 6% in 2025 to an average of $26,993 per year for family coverage, data shows annual examination employers, published Oct. 22 by KFF, a nonprofit health information organization that includes KFF Health News. Despite all the attention paid to food, gas and energy prices, insurance premiums and deductibles have risen in recent years. faster than general inflation and wages.
Democratic headwinds
Appetite for big, bold ideas to bring down such high costs has waned, in part because Democrats lack political leverage, according to economists, political strategists and health care advocates. They've been burned before for supporting significant change.
For example, after the ACA was passed in 2010, backlash against the law—and its requirement that nearly everyone have insurance—helped Republicans win the House and Senate seats. In 2016, Democratic presidential candidate Hillary Clinton endorsed public optiona government-proposed plan that would compete with commercial insurance. She lost to Donald Trump.
Democrats are also in the minority in Congress. Radical changes in health care, such as the creation of Medicaid and Medicare and the passage of the ACA, happened historically when one party controlled both Congress and the presidency. Republicans currently have all these muscles. So for now, Democrats are fighting to maintain the status quo, portraying Republicans as a threat to Americans' insurance coverage.
If ACA subsidies are not extended, many of the roughly 24 million people who buy insurance through the health law's marketplaces will see their premiums more than doubled next year, according to KFF. A KFF Health Tracking Survey published on November 6, it was revealed that three-quarters of the public supported their extension.
“There is no doubt that people believe the current system needs reform,” he said. Jesse Fergusondemocratic strategist. “Part of that is protecting people from rising insurance premiums. You don't gain the future by losing the present.”
Even bipartisan legislative proposals aimed at lowering health care costs have failed amid political threats and partisan attacks on social media.
Bills that could increase health care price transparency and limit companies that administer prescription drug benefits have gained traction in late 2024 as part of a spending package. Then Elon Musk, who served as a senior adviser to President-elect Trump, took to his social media platform X to rally the opposition, ridiculing the budget bill for what he claimed was excessive government spending.
GOP leaders have abandoned the health care provisions, prompting Sen. Patty Murray (D-Wash.) to say on X that Musk “tweeted to kill» bipartisan health care policies developed by Congress.
But Democrats' focus on health care cuts both ways. Their messages, amid efforts to save the ACA from repeal and preserve the law's protections for those with pre-existing conditions, helped the party return the house in the 2018 midterm elections. “I still have post-traumatic stress disorder from that experience,” Republican Mike Johnson, now Speaker of the House of Representatives, said recently.
And voters want relief. Six in 10 Americans are extremely or very concerned about rising health care costs in the next year, according to the study. Poll by Associated Press and NORC Center for Public Affairs Research.
Hagen WenzekThe 56-year-old man is one of them. The CEO of GI Digital, a high-tech startup, felt pain in his calf late in the summer and asked ChatGPT OpenAI what it could be. It was thought he may have had deep vein thrombosis or a blood clot. He went to the emergency room and had an ultrasound, which confirmed the diagnosis, so doctors monitored him and gave him blood thinners.
His insurance billed $7,422, while Wenzek received a bill for $890. average cost According to GoodRx, a digital health platform, ultrasounds cost about $400 without insurance.
“The hospital makes thousands of dollars for a procedure that costs $500. It's pretty ridiculous,” said Wenzek, of Sleepy Hollow, New York. “I have a $40 copay just to go to the doctor for anything, and I have a startup budget.”
“Defending the status quo”
The lack of bolder ideas to combat rising costs could also work against Democrats, some critics say. Comedian and political commentator Jon Stewart accused Democrats of “malpractice” in an October episode of his podcast by failing to present ideas to fix what people hate about the health care system. Instead, he said, they are shutting down the government to protect a system that voters say is failing them.
“Once again, Democrats are in a position to defend the status quo of policies that most people in the United States think suck,” he said. “Meanwhile, on the same day, Trump launches TrumpRx. Hey, I'll just threaten Pfizer with 100% tariffs and then just open up the prescription drug outside of middle management and sell it directly to the public at a discount.»
TrumpRxwhich aims to help patients find cheaper drugs, and Big Pharma's promises to lower drug prices could help the GOP with voters, although Democrats are also attacking Republicans over the One Big Beautiful Bill Act, a bill the president signed into law in July that cuts Medicaid spending by about $1 trillion over a decade.
Republicans are vowing to turn the situation around, using lockdowns to try to exploit voter frustration. Vice President J.D. Vance said. Newsmax in October that “we actually have a plan,” referring to the issue of health care reform. (Trump has repeatedly promised that he would come up with a plan to replace the ACA, but has never done so.)
Senate Majority Leader John Thune said on CNBC in October, Trump wants to overhaul the ACA and “give people better, more affordable health insurance.”
The White House did not respond to Vance's email seeking comment.
“It’s not that Democrats are focusing on tax breaks to the exclusion of bigger, bolder reforms,” he said. Anthony Wrightexecutive director of Families USA. “If you can talk about health care, if we can prevent insurance premiums from skyrocketing, then we can focus on why health care costs so damn much to begin with.”
But some Democrats say voters are hurting and now want bigger, bolder ideas. Earlier this year, Minnesota Gov. Tim Walz said on the Fast Politics podcast that the party should offer more on health care in the next elections.
“I’ll tell you what people will expect,” he said. “They won't expect us to experiment with the ACA. They will expect universal health care.”
At least for now the states have more innovative ideas. Oregon established a governing board to create single payer health care system in which the government would take over healthcare financing, eliminating private insurance, premiums and all deductibles for all residents by 2027. The question is whether it will work. Vermont abandoned such efforts in 2014.
“Given the political environment we find ourselves in, there is currently no appetite for big reforms, but we know they have to happen,” he said. Mona Shahsenior director of policy and strategy for Community Catalyst, a health advocacy group. “Regardless of party lines, people want government intervention in health care, and people want universal coverage. The pain point that people feel, public opinion, is where we were before the ACA.”
