WASHINGTON — The first call to the phone town with Maryland Representative Andy Harris, leader of the conservative House Freedom Caucus, came with a question about the Affordable Care Act. Her cousin's disabled son is at risk of losing the insurance he received. according to this law– said the caller.
“Now she's looking at two or three times what she paid for insurance,” said a woman named Lisa from Harford County, Maryland. “I would like you to clarify what the Republican 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 ensure that all premiums come down,” he said, predicting that Congress will “probably negotiate some sort of rollback” later.
His uncertainty reflected a familiar Republican dilemma: Fifteen years after passage of the Affordable Care Act, the party remains united in its criticism of the law but divided on how to move forward. This tension came into sharp focus during government shutdown as Democrats seize on rising insurance premiums Republican pressure to extend expiring subsidies under the law often called Obamacare.
President Donald Trump and GOP leaders say they will consider extending expanded tax breaks that would otherwise expire at the end of the year, but only after Democrats vote to reopen the government. Meanwhile, people on plans have already been notified of significant premium increases in 2026.
As town halls fill with disillusioned voters and a lack of clear Republican plan appearsthe problem seems to be gaining political power ahead of next year's midterm elections.
“Premiums are going up whether they are renewed or not,” said Republican Sen. Rick Scott. “Premiums are going up because health care costs are going up. Because Obamacare is a disaster.”
At the center of the shutdown, now in its fourth week with no end in sight, is the Democratic Party's demand for an extension of the 2021 Affordable Care Act subsidies.
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 am seriously considering alternatives.”
Speaking about health care during the September 2024 presidential debate, Trump said he had “concepts of a plan.”
But nearly 10 months into his presidency, the plan has yet to materialize. Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, told NBC on Wednesday, “I have every confidence that the president has a plan,” but did not elaborate.
Republicans say they want a broader overhaul of the health care system, although such a plan will be difficult to implement until next year. Party leaders have not said how they will handle the expiring tax cuts, insisting they will not negotiate on the issue until Democrats agree to end the shutdown.
A September analysis by the nonpartisan Congressional Budget Office found that permanently extending the tax cuts would increase the deficit by $350 billion between 2026 and 2035. The number of people with health insurance will grow by 3.8 million in 2035 if benefits are maintained, the CBO projects.
Asked Wednesday on CNN if Republicans had a plan to address the subsidies if the government reopens, House Speaker Mike Johnson said they had “proposals” that could be “ready immediately.”
“This is a very complex issue that takes a long time to reach consensus,” he said.
With notifications about premium studs Hitting mailboxes now, with the open enrollment period for health insurance plans under the Affordable Care Act beginning on November 1, the political pressure in Republican town halls is clear.
In Idaho, Rep. Russ Fulcher told concerned callers that “public health care is the wrong way” and that “private health care is the right way.” In Texas, freshman Rep. Brandon Gill responded to a caller facing steep increases in insurance premiums, saying Republicans are focused on cutting waste, fraud and abuse.
Harris echoed a message shared by many in his party during a Maryland town hall, saying spending is “simply going back to where it was before COVID.”
But the number of people relying on health insurance under the Affordable Care Act has increased markedly compared to pre-pandemic times. More than 24 million people enrolled in marketplace plans in 2025, up from about 11 million in 2020, according to an analysis by health research nonprofit KFF.
Sarah of Middleville, Michigan, told Rep. John Moolenaar during his town hall that if health insurance premiums increased by as much as 75%, most people would likely go without health care. “So how do you feel about this?” she asked.
Moolenaar, who represents a constituency he won easily last year, responded: “We have time to negotiate, develop a plan for the future, and I think that can happen.”
Some Republicans expressed grave concern. In a letter sent to Johnson, a group of 13 battleground House Republicans wrote that the party must “immediately address the growing healthcare affordability crisis” 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 reject predictions that ACA premiums would more than double without subsidies, calling them exaggerated and arguing that the law fuels fraud and abuse that needs to be curbed.
Many Democrats attribute 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 4 in 10 American adults say they believe Democrats are doing a better job on health care, compared with about a quarter who trust Republicans more. recent AP-NORC poll found. About a quarter trust neither party, and about 1 in 10 trust both parties equally, according to the poll.
Even as GOP leaders promise to discuss ending the subsidies when the government reopens, it is clear that many Republican lawmakers are adamantly opposed to an extension.
“There is a growing understanding, 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 research at the libertarian Cato Institute, said he is working with several congressional offices on alternatives that would end the subsidies. For example, he wants to extend the Affordable Care Act exemption granted to U.S. territories to all 50 states and reintroduce Trump's first-term policies 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 implement his ideas “sooner rather than later.”
David McIntosh, president of the influential conservative group Club for Growth, told reporters Thursday that the group “urged Republicans not to renew COVID-era subsidies.”
“We have a big cost problem,” McIntosh said.
“I think most people would say, 'Okay, I've had a lot to do during COVID,'” he said. “But now everything is back to normal and I have to pay for medical care.”
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Swenson reported from New York.
