Notices of rising health insurance premiums for 2026 have started arriving in mailboxes across the United States, igniting a wave of frustration among voters and intensifying the political debate over the future of the Affordable Care Act (ACA). As the government shutdown stretches into its fourth week, pressure is mounting on lawmakers to address surging health care costs, with both parties trading blame and offering few concrete solutions.
During a recent telephone town hall, Maryland Representative Andy Harris, a leading figure in the House’s conservative Freedom Caucus, fielded a pointed question from a constituent. Lisa from Harford County, Maryland, shared her family’s story: her cousin’s disabled son, who gained insurance under the ACA, is now facing premiums that are two or three times higher than before. "I’d love for you to elucidate what the Republicans’ plan is for health insurance?" she asked, according to the Associated Press.
Harris’s response was emblematic of the Republican Party’s ongoing struggle with health care policy. "We think the solution is to try to do something to make sure all the premiums go down," he said, suggesting that Congress would "probably negotiate some off-ramp" later. But a clear plan was noticeably absent, underscoring a tension that has persisted for years: while Republicans remain united in criticizing the ACA, they are deeply divided on how to move forward.
This division is coming to a head as Democrats seize on the issue of rising premiums, using it as leverage in the ongoing government shutdown. Their central demand is straightforward: extend the enhanced ACA subsidies passed in 2021, which are set to expire at the end of the year. President Donald Trump and Republican leaders have stated they will consider extending these tax credits—but only after Democrats vote to reopen the government.
Meanwhile, voters enrolled in ACA plans are already receiving notices of significant premium hikes for 2026, fueling anxiety and anger. The timing couldn’t be more politically sensitive, with the open enrollment period for ACA health plans set to begin on November 1, 2025. Town halls across the country have become forums for voters to vent their frustrations, and lawmakers are feeling the heat.
In Idaho, Representative Russ Fulcher told concerned callers that "government provided health care is the wrong path" and that "private health care is the right path." In Texas, freshman Representative Brandon Gill responded to a constituent facing a sharp premium increase by emphasizing the Republican focus on cutting waste, fraud, and abuse. Harris, in Maryland, echoed a common refrain: costs are "just going back to what it was like before COVID."
Yet the landscape has changed dramatically since the pandemic. According to the nonprofit health care research group KFF, more than 24 million people were enrolled in marketplace plans in 2025, up from about 11 million in 2020. The ACA has become an essential source of coverage for millions, and the prospect of losing subsidies—or facing unaffordable premiums—has rattled households nationwide.
Some Republicans, particularly those in battleground districts, are sounding the alarm. In a letter to House Speaker Mike Johnson, a group of 13 GOP lawmakers urged the party to "immediately turn our focus to the growing crisis of health care affordability" once the shutdown ends. "While we did not create this crisis, we now have both the responsibility and the opportunity to address it," they wrote, as reported by the Associated Press.
Still, the party remains split. Many Republican leaders insist they will not negotiate on extending the subsidies until Democrats agree to end the shutdown, and no detailed alternative has been presented by President Trump—despite repeated promises. During a September 2024 presidential debate, Trump said he had "concepts of a plan," but nearly 10 months into his presidency, that plan remains unseen. Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, told NBC, "I fully believe the president has a plan," but offered no specifics.
Some within the party are pushing for broader changes. Michael Cannon, director of health policy studies at the libertarian Cato Institute, told the Associated Press he is working with multiple congressional offices on alternatives that would let the subsidies expire. One idea is to expand the ACA exemption given to U.S. territories to all 50 states and to reintroduce a first-term Trump policy allowing Americans access to short-term health insurance plans outside the ACA marketplace. David McIntosh, president of the conservative Club For Growth, said his group has "urged the Republicans not to extend those COVID-era subsidies," arguing, "We have a big spending problem."
The financial stakes are significant. A September 2024 analysis by the nonpartisan Congressional Budget Office estimated that making the tax credits permanent would increase the federal deficit by $350 billion from 2026 to 2035, while boosting the number of insured Americans by 3.8 million in 2035. These figures are fueling a fierce debate within the GOP, with some dismissing projections of skyrocketing premiums as exaggerated and pointing to what they see as fraud and abuse within the ACA system.
Democrats, for their part, are seizing the moment. Many credit their 2018 takeover of the House to the GOP’s attempt to repeal Obamacare during Trump’s first term, and they see a similar opportunity in the current climate. Polling suggests the public may be on their side: about four in ten U.S. adults say they trust Democrats to handle health care better, compared to about one-quarter who trust Republicans more, according to a recent AP-NORC poll. About a quarter trust neither party, and roughly one in ten trust both equally.
Amid the political wrangling, the real-world consequences are front and center for voters. During a Michigan town hall, Sara from Middleville told Representative John Moolenaar that if premiums rise by as much as 75%, most people will likely forgo health care altogether. "So how do you address that?" she asked. Moolenaar’s answer, like many of his colleagues, was noncommittal: "We have time to negotiate, figure out a plan going forward and I think that’s something that could occur."
Some observers, like Brian Blase, president of the Paragon Health Institute and a former Trump health policy adviser, see a growing sense among Republicans that "just maintaining the status quo is very destructive." But as town halls fill with angry voters and the open enrollment period looms, the lack of a clear path forward is hard to ignore.
Adding to the complexity is the broader context of voter attitudes and misunderstandings. As Jonathan V. Last noted in a recent Focus Group discussion highlighted by The Bulwark, many voters harbor misconceptions about political realities and policy issues—including health care. This confusion can make it even harder for lawmakers to communicate solutions or build consensus.
With the shutdown dragging on and premium notices piling up, both parties face growing pressure to act. Whether a compromise emerges—or whether the stalemate continues—remains to be seen. For millions of Americans, the stakes could hardly be higher.
