Obamacare’s Broken Promises and Washington’s Latest Health Care Standoff

Nevada County voters are accustomed to practical problem-solving. We value fiscal responsibility, personal accountability, and transparent leadership over political theater. Yet today, as Washington debates the future of Affordable Care Act (ACA) subsidies and approaches another health care funding deadline, many Americans are once again hearing blame and deflection rather than clear explanations of how current policy choices produced this moment.

The current debate over ACA subsidies and the pending expiration of enhanced premium tax credits on December 31, 2025, is rooted in policy decisions made over multiple Democratic administrations, from the ACA’s original design under President Obama, to the Biden administration’s pandemic-era expansion, and the temporary timelines chosen for those subsidies. These choices have produced a predictable policy cliff now confronting lawmakers.

Promises and Outcomes of the Affordable Care Act

When President Barack Obama championed the Affordable Care Act in 2009–10, he made assurances intended to reassure the public, including that Americans who liked their health insurance plans or doctors would be able to keep them. These statements were repeated even as analysts warned that the new law’s regulatory requirements would likely disrupt parts of the individual insurance market. In practice, millions of Americans, particularly those with individual plans, saw their coverage canceled or substantially altered to comply with the law’s new standards. My own family experienced this disruption firsthand, with coverage becoming unaffordable before being canceled altogether and replaced with an ACA marketplace plan, and no we weren’t able to keep our doctor.

President Obama also argued that the ACA would reduce premiums and slow overall health care cost growth. While the law expanded coverage, most Americans continue to receive insurance through employers, Medicare, or Medicaid, not through ACA exchanges. Premiums in many markets have continued to rise, and national health care spending has grown faster than wages and general inflation. Independent analyses have shown that the ACA did not produce the broad, system-wide cost reductions initially promised by its proponents, Democrats.

These outcomes are relevant because they frame the policy decisions that followed.

Pandemic Subsidies: Temporary by Design

In 2021, Congress enacted the American Rescue Plan Act in response to the COVID-19 pandemic. Among its provisions were enhanced premium tax credits for ACA marketplace enrollees. These changes increased subsidy amounts and removed the upper income cap that previously limited eligibility to households earning up to 400% of the federal poverty level (FPL). Keep in mind when these subsidies expire households below 400% of FPL will still be eligible for standard ACA subsidies in 2026 and beyond.

Putting this in perspective, of the roughly 24 million people enrolled in ACA marketplace plans, an estimated 1.6 million have incomes above 400% of the FPL and an additional roughly 1 million enrollees have missing income data and are likely above that threshold. The national debate and the record 43-day Democratic government shut down was for the approximately 2.6 million ACA enrollees!

The immediate effect of removing the 400% cap was a reduction in monthly premiums for many enrollees, contributing to record ACA marketplace enrollment. However, these enhanced subsidies were explicitly temporary. They were initially scheduled to expire after 2022 and were later extended through the end of 2025 by the Inflation Reduction Act of 2022, legislation that again passed without Republican support.

Absent new legislation, these enhanced subsidies expire at the end of this year, reverting the ACA to its pre-pandemic subsidy structure back to the initial design of ACA. As a result, many enrollees, approximately 2.6 million are projected to face substantial premium increases, in some cases exceeding 50 percent or more, depending on age and income. This outcome reflects the structure of the law as written initially, not an unforeseen development.

While all marketplace enrollees currently receiving enhanced subsidies could see some premium adjustment, the most severe increases are concentrated among the approximately 2.6 million enrollees above the 400% FPL income threshold, who would lose subsidy eligibility entirely. Enrollees below that level would continue to receive ACA subsidies, though at less generous levels than under the pandemic-era expansion

Washington’s Current Standoff

Democrats in Congress have proposed legislation to extend the enhanced subsidies beyond 2025, while Republicans have advanced alternative approaches, including Health Savings Account–based proposals and other cost-containment measures. Neither approach has secured the bipartisan support necessary to overcome a Senate filibuster.

This impasse highlights a broader issue: the enhanced subsidies were enacted and extended on a temporary basis through party-line legislation, without a bipartisan financing framework capable of sustaining them beyond a single political cycle. The current debate reflects that unresolved structural choice.

Fiscal Considerations

Extending the enhanced subsidies indefinitely carries significant fiscal implications. The Congressional Budget Office has estimated that a permanent extension for the estimated 2.6 million current ACA enrollees earning 400% above the FPL would cost hundreds of billions of dollars over the next decade, increasing federal deficits absent offsetting revenue or spending reductions. These projections are not partisan claims, but budgetary estimates produced by independent analysts.

Responsible policymaking requires acknowledging these costs and addressing how they would be financed.

Responsibility and Policy Design

The enhanced subsidies were created, expanded, and extended through Democratic majorities. Their temporary nature was explicit at each stage. If lawmakers intended these subsidies to become permanent, they could have pursued bipartisan legislation or identified a durable funding mechanism at the outset. The current situation reflects the consequences of temporary policy design rather than a sudden change in circumstances.

A Call for Bipartisan Solutions

There is historical precedent for more durable, bipartisan health care reform. When Medicaid was enacted in 1965 alongside Medicare as part of the Social Security Amendments, it passed Congress with significant support from both Democrats and Republicans. While Democrats led the effort, Republican votes contributed to its enactment and political legitimacy. That bipartisan foundation helped Medicaid endure for decades without recurring expiration deadlines or crisis-driven extensions.

Affordable health care remains a shared American concern. Durable solutions require bipartisan cooperation, clear cost estimates, and policies designed to endure beyond shifting political majorities or temporary emergency measures. Without such an approach, health care policy risks continuing to cycle from one fiscal deadline to the next, undermining public confidence and long-term stability. I hesitantly suggest kicking the enhanced subsidies down the road with a one-year extension, allowing the incoming Congress in 2026 to pursue a comprehensive health care reform effort.