OPINION: What Were They Thinking?

"Regrettably, we’re fighting about subsidies for the ACA when we should really be focused on changing the system to one that works by being both affordable and universal."

By Jay Brock
GUEST WRITER

Photo by Marek Studzinski on Unsplash

What were they thinking?

Unaffordable healthcare is one of the great kitchen table issues affecting most Americans today: KFF, the healthcare think tank, last year reported that three-quarters of Americans across the country worry about being able to afford to pay their medical bills if they get sick.

So what were Republicans thinking last month when they refused to extend the government subsidies that helped 20 million Americans pay their Affordable Care Act (ACA) monthly premiums?

Given that Republicans are already perceived as being miserly with healthcare dollars after having cut Medicaid funding for poor people last year with President Trump’s Big Beautiful Bill—where 17 million Americans were expected to lose their health insurance—you’d think that Republicans would want to change the perception that they don’t really care that so many Americans struggle with medical bills.

This is especially so with the prospect of midterms coming later this year that will be especially challenging for Republicans, given the low approval ratings for the Trump Administration.

What were they thinking?

But it’s not just Republicans: what were Democrats thinking when they passed the Affordable Care Act—“Obamacare”—back in 2010?

President Obama was elected with strong Democratic majorities in the House and Senate in 2008. But when it came to reforming our unaffordable health insurance system, he aimed low, hoping to get Republican buy-in, and thinking that you couldn’t put the toothpaste back in the tube, rather than acknowledging the need for a brand new tube of toothpaste when it came to health insurance. So rather than implementing a new health insurance system that would finally give everyone in America affordable healthcare, he instead opted for incremental changes within the current system in the vain hope that he could get Republicans on board. (In the end, only a single Republican did.)

So the ACA, despite some real improvements, such as eliminating pre-existing conditions as a criterion for coverage, did not result in healthcare that was either affordable or universal.

In fact, it’s fair to call the ACA the “Unaffordable Care Act.” This year, the average monthly individual premium is about $750, but costs will vary widely depending on the type of plan chosen, age of the enrollee, where you live, and health insurance company. For example, a 21 year old on a “Silver” plan might spend $600/month, while a 60 year old on the same plan would pay $1,600/month. Families of course pay more—and unless Washington at the last minute decides otherwise, now without subsidies.

Monthly health insurance premiums with the ACA are so high that more than nine out of 10 of the 24 million people on the ACA in 2025 have needed government subsidies to help pay them. Once these subsidies disappear, it’s expected that another 4 million Americans will lose their health insurance. For the rest, premiums will range from burdensome to onerous.

And then, like other insurance plans, there are the ACA deductibles—the out-of-pocket costs the enrollee must pay before the health insurance policy really kicks in to cover costs of care. These can also vary widely, depending on the plan. While the average is just shy of $3,000 in 2026, ACA deductibles will generally run anywhere from about $800 to $7,500 for the year—hardly affordable, especially if you need government subsidies to afford the monthly premiums.

In other words, if the goal is to make healthcare both affordable and universal, the ACA is clearly not helping.

As beneficial as premium subsidies may be to the individual (and of course for the health insurance industry), for the nation it’s throwing good money after bad: these subsidies help perpetuate a failed and costly health insurance system.

So when Democrats claim that the best way to “fix” healthcare is with the ACA, you have to ask: “What were they thinking?”

And when Republicans demand that Obamacare must be “repealed and replaced,” they have a point. Unfortunately, what Republicans do NOT have is the foggiest idea of what to replace the ACA with: their idea seems to be to perpetuate the current system—a non-starter.

The lesson learned here is that building on the current system to reach the goal of universal affordable healthcare will not work. The current system is simply too complicated, too expensive to run, and too willing to put patients last financially.

Regrettably, we’re fighting about subsidies for the ACA when we should really be focused on changing the system to one that works by being both affordable and universal. Given how important this is for so many voters, you’d think that real health insurance reform would be a bipartisan effort, with most politicians stumbling over each other to get in line for a truly affordable system. A single payer system (Medicare for All) is already on the table.

Yet that bipartisan support is absent.

What were they thinking?

Local Obituaries

To view local obituaries or to send a note to family and loved ones, please visit the link that follows.

Support Award-winning, Locally Focused Journalism

The FXBG Advance cuts through the talking points to deliver both incisive and informative news about the issues, people, and organizations that daily affect your life. And we do it in a multi-partisan format that has no equal in this region. Over the past year, our reporting was:

• First to break the story of Stafford Board of Supervisors dismissing a citizen library board member for “misconduct,” without informing the citizen or explaining what the person allegedly did wrong.

• First to explain falling water levels in the Rappahannock Canal.

• First to detail controversial traffic numbers submitted by Stafford staff on the Buc-ee’s project

Our media group also offers the most-extensive election coverage in the region and regular columnists like:

• Drew Gallagher — Humorist

• Dennis Wemm — Theatre Critic

• Hank Silverberg — Transportation

• Bruce Saller — Environment

And our newsroom is led by the most-experienced and most-awarded journalists in the region — Adele Uphaus (Managing Editor and multiple VPA award-winner) and Martin Davis (Editor-in-Chief, 2022 Opinion Writer of the Year in Virginia and more than 25 years reporting from around the country and the world).

• For just $8 a month, you can help support top-flight journalism that puts people over policies.

Your contributions 100% support our journalists.

Help us as we continue to grow!

This article is published under Creative Commons license CC BY-NC-ND. It can be distributed for noncommercial purposes and must include the following: “Published with permission by FXBG Advance.”