As millions of Americans prepare to sign up for health insurance during the Affordable Care Act’s (ACA) open enrollment period this November, a storm of political discord and skyrocketing premiums has left the nation’s health care system in the spotlight once again. According to multiple reports from The Wall Street Journal, AP News, The New York Times, and others, more than 20 million people who buy insurance through the ACA marketplaces are bracing for their premiums to double or even triple in 2026. Meanwhile, those with employer-sponsored insurance are facing a 6 percent average increase, pushing annual family coverage to an eye-watering $27,000—a 26 percent jump since 2020.
Behind this sticker shock lies a high-stakes standoff in Washington. At the heart of the ongoing government shutdown is a dispute over whether to extend the enhanced federal subsidies that have helped keep ACA premiums affordable for tens of millions. Democrats are holding firm, refusing to back any spending bill that doesn’t include an extension of these tax credits. Republicans, on the other hand, have so far refused to negotiate on the issue, arguing that the ACA is fundamentally flawed and that Democrats are responsible for the current crisis.
President Donald Trump, who is now midway through his second term, added fuel to the fire with a series of statements aboard Air Force One en route to South Korea on October 29, 2025. As reported by The Hill and Nexstar Media, Trump declared, “We have to fix health care because ObamaCare is a disaster. When you see the increases in ObamaCare, it never worked. It never will work, and we can do something with the Democrats much better than ObamaCare. Less money and better health care. And I think that’s something that could come out of this with the Democrats. We work with the Democrats.”
Trump’s comments, which seemed to suggest an openness to bipartisan negotiation, came as a surprise to many observers. The president has long been a vocal critic of the ACA, and his first term was marked by a dramatic—ultimately failed—attempt to repeal and replace the law in 2017. “I think it’s a great time for the Republicans and Democrats to get together and make something that will work, and let the insurance companies make money—they’re entitled to that, but not the kind of money that they’re making,” Trump added, as quoted by The Hill.
Yet for all the talk of compromise, the path forward remains muddled. Trump’s Secretary of Health and Human Services, Robert F. Kennedy Jr., has championed the idea that Americans need to improve their health behaviors or face consequences—a stance that echoes longstanding Republican skepticism about government intervention in health care. Meanwhile, Trump’s own signature legislation this year, the One Big Beautiful Bill Act, slashed Medicaid benefits relied upon by lower-income Americans, further complicating prospects for bipartisan agreement.
On the Republican side, the lack of a clear alternative plan has become a glaring vulnerability. Senator Bernie Moreno (R-Ohio) faced tough questions on CNN’s “The Source” on October 28, 2025, when anchor Kaitlan Collins pressed him for details on the GOP’s solution to rising health care costs. Moreno insisted, “Republicans did not vote for Obamacare. They did not vote for these Biden-era COVID subsidies. The Democrats did.” When asked to specify the Republican plan, he replied, “The whole system can be looked at very holistically. But it’s going to take three or four months to really bring a consensus to that plan. In the meantime, what are we going to do? Keep the government closed, for three or four months every time that we have a policy debate? This is nuts.”
Moreno’s evasive answers highlighted a broader truth: despite years of railing against the ACA, Republicans have yet to present a comprehensive replacement. As Collins pointed out, “There’s been 15 years since Obamacare passed. We haven’t seen a Republican plan to replace it.” Moreno deflected, blaming Democrats for the current predicament and calling Obamacare “objectively terrible.”
For everyday Americans, the political finger-pointing offers little comfort. As open enrollment approaches, the reality is grim. Reports from Forbes, Bloomberg, and WAVE News describe widespread frustration and anxiety among families who rely on ACA coverage. Many are discovering that their premiums for 2026 will be unaffordable without continued federal assistance. The government shutdown has only deepened the sense of uncertainty, with some fearing they may be forced to forgo coverage altogether.
It’s a bitter irony, given the ACA’s original promise. When President Barack Obama signed the law in 2010, he pledged to make health care more affordable for families, businesses, and the federal government. And in some respects, the ACA has delivered: the uninsured rate in America is now about 8 percent, half of what it was before the law passed, and more than 40 million people have gained coverage through the marketplaces or Medicaid expansion. Insurance companies can no longer deny coverage for preexisting conditions, and many preventive services are covered at no cost.
But as Vox and The New York Times have noted, the ACA was designed primarily to expand coverage, not to control costs. For the majority of Americans—especially those with employer-sponsored plans—the law’s impact on affordability has been limited. Premiums have continued to rise steadily, and the rate of underinsurance (when people have coverage but still can’t afford their medical bills) has crept upward. The law’s requirements for insurers to cover everyone and provide a broader suite of benefits have, in some cases, pushed costs higher.
Democrats argue that extending the enhanced subsidies is essential to prevent millions from losing affordable coverage and to avoid a public health crisis. They point out that the ACA’s Medicaid expansion alone is credited with saving more than 27,000 lives between 2010 and 2022. Progressives insist that it’s better for the government to pick up the tab—even as costs rise—than to let Americans go without care.
Republicans, for their part, maintain that the ACA’s failure to rein in costs proves it was a flawed solution from the start. They criticize Democrats for holding the government hostage over subsidy extensions and warn that simply pouring more money into the system is unsustainable. Some in the GOP have floated ideas for price regulation or market-based reforms, but a detailed, unified plan remains elusive.
With the shutdown dragging on and open enrollment looming, the stakes couldn’t be higher. If Congress fails to act, millions face the prospect of losing coverage or being crushed by unaffordable premiums. As Bloomberg put it, this year’s open enrollment might just give Americans the worst sticker shock yet.
For now, the future of American health care hangs in the balance—a reminder that, despite years of debate and reform, the quest for truly affordable coverage remains unfinished business.
