Greetings, readers. While I may not consider myself a victim of the Democrats’ capitulation in the recent shutdown, I still feel a sense of disappointment over this display of weakness. Although unforeseen obstacles could still affect the Republican agenda, we cannot overlook how disgraceful this decision was, regardless of any potential turnaround. The agreement the Democrats accepted was essentially the same deal that was offered a month ago, with no additional concessions to show for it. This lack of progress is infuriating. A lengthy shutdown has already caused significant stress and expenses across the nation, and yet we see no gains, especially in the critical arena of healthcare.
As many of you are aware, the key issue in this debate revolves around the impending expiration of Covid-related subsidies for Obamacare, specifically tax credits that have kept premium increases at bay. By 2026, individuals will face considerable hikes without any support to cushion the blow. This predicament may lead to fewer people participating in insurance plans, particularly those feeling healthy enough to assume the risk of higher costs. A reduced pool of healthy participants will naturally skew towards sicker individuals, resulting in even steeper rates. Although experts have made estimates on this decline, the actual figures are likely to be worse than anticipated given the current inflationary pressures and job market instability.
Regarding the idea of Medicare for All, a non-partisan critique by ProPublica from 2019 offers insights into its waning momentum. The term is often misleadingly used as a stand-in for comprehensive healthcare for all citizens, yet lacks specific details on what such a system would entail.
In the following section, KFF outlines how political leaders have seemingly given up on tackling the escalating costs and deterioration of healthcare, despite voters consistently identifying these as priority issues.
By Stephanie Armour. Originally published at KFF Health News
During the 2020 elections, all 20 Democratic presidential candidates promised bold reforms in healthcare, advocating for a government-run insurance system or an expansion of Medicare to cover all Americans.
Fast-forward to the current congressional deadlock that has led to a government shutdown lasting over a month. Democrats, entrenched in their stance, have tied their political future to preserving parts of the Affordable Care Act. This is a stark contrast to the sweeping health policy reforms they once argued were essential for addressing soaring healthcare costs.
Through determined efforts, Democrats brought national attention to the rising costs of health insurance, insisting they would withhold funding for the federal government until a deal could be struck to renew the more generous subsidies that have helped lower Obamacare premiums. Their resilience may well pay off in the upcoming midterm elections.
However, healthcare prices continue to surge, high-deductible plans are becoming more prevalent, and 40% of adults are burdened by some form of healthcare debt. The gap between voters’ calls for aggressive reform and the current lack of urgency in Washington is glaring, especially as healthcare costs reach a crisis level.
“There isn’t much enthusiasm among politicians,” said Jonathan Gruber, an economist who played a pivotal role in drafting the ACA. “Why aren’t they being bolder? They likely carry scars from previous ACA battles. But healthcare is a winning issue. The reality is, we need universal coverage and price regulation.”
Votes indicate that lowering healthcare costs is a top priority, surpassing concerns about housing, jobs, immigration, and crime, according to a September poll by Hart Research Associates for Families USA, a health advocacy organization.
As costs continue to escalate, premiums for employer-sponsored health insurance rose by 6% in 2025, averaging $26,993 annually for family plans, according to an annual employer survey released by KFF on October 22. Despite all the focus on other rising costs, health premiums and deductibles have increased at a rate faster than overall inflation and wages in recent years.
Data from KFF reveals that 2025 marked the first time in two decades that the annual cost of insuring a family of four rose by 6% or more for three straight years.
The decreasing appetite for ambitious reforms aimed at reducing these high costs appears to stem from Democrats’ lack of political leverage, according to economists, political strategists, and healthcare advocates. Many are still cautious due to past experiences with substantial changes.
For instance, after the ACA was implemented in 2010, backlash over its insurance mandate led to Republican gains in both the House and Senate. In 2016, Democratic presidential candidate Hillary Clinton supported the public option but ultimately lost to Donald Trump.
Current congressional dynamics complicate the situation further. Historically, significant healthcare reforms like Medicaid, Medicare, and the ACA have emerged when one party maintains control over both Congress and the presidency. Presently, Republicans hold that power. Consequently, Democrats find themselves fighting to maintain the current system while positioning Republicans as a threat to Americans’ health insurance coverage.
If the subsidies under the ACA aren’t renewed, approximately 24 million people purchasing the plan through health law marketplaces could see their premiums double next year, according to KFF. A recent KFF Health Tracking Poll showed that 75% of the public supports the extension of these subsidies.
“There’s no doubt that people feel the current system requires reform,” stated Jesse Ferguson, a Democratic strategist. “Safeguarding against premium hikes is part of that reform. You don’t secure your future by neglecting the present.”
Even bipartisan efforts aimed at reducing healthcare costs have fallen flat amid heightened political battles and divisive social media campaigns.
Legislation aimed at enhancing healthcare cost transparency and regulating prescription drug benefit managers gained momentum in late 2024 as part of a spending package. However, opposition from figures like Elon Musk, then a senior adviser to President-elect Trump, swayed GOP leaders to abandon the health provisions after he criticized the budget bill for alleged excessive spending on his platform, X.
Democrat Patty Murray (D-Wash.) remarked on X that Musk “tweeted to kill” the bipartisan health policies Congress had worked hard to develop.
Yet, while Democrats have focused on healthcare, this strategy has had mixed results. Their messaging while defending the ACA and attempting to secure patients with preexisting conditions benefitted them by helping the party regain the House in the 2018 midterms. “I still have PTSD from that period,” stated Republican Mike Johnson, who is now the House Speaker, recently.
Public concern about healthcare costs remains high, with six in ten Americans expressing deep worries about rising expenses next year, according to an Associated Press-NORC Center for Public Affairs Research poll.
Hagen Wenzek, a 56-year-old CEO of GI Digital, shares this concern. After experiencing pain in his calf last summer, he consulted ChatGPT, which suggested he might have deep vein thrombosis. Following an emergency room visit and subsequent ultrasound that confirmed the diagnosis, he faced a $7,422 bill for the procedure, leaving him to pay $890 after insurance. The average ultrasound cost is roughly $400 without insurance, according to GoodRx.
“The hospital profits immensely from a procedure that only costs about $500. It’s absurd,” said Wenzek, hailing from Sleepy Hollow, New York. “I have a $40 copay just to see a doctor for any issue, and I’m operating on a startup budget.”
‘Defending the Status Quo’
The absence of ambitious proposals to address soaring healthcare costs could backfire on the Democrats, some critics warn. Comedian and political commentator Jon Stewart recently accused Democrats of committing “malpractice” for failing to propose solutions to the issues that frustrate voters about the healthcare system. Instead, he argued, they are merely maintaining a system that many Americans feel is letting them down.
“Once again, the Democrats find themselves defending a status quo that the majority of Americans view unfavorably,” he expressed. “Meanwhile, Trump has introduced TrumpRx. My plan? Threaten Pfizer with 100% tariffs, then sell medication directly to the public at a discount, circumventing middlemen.”
TrumpRx aims to help patients access lower-priced medications, while commitments from pharmaceutical companies to reduce drug prices may bolster the GOP’s appeal to voters, even as Democrats criticize Republicans for the One Big Beautiful Bill Act, which reduces Medicaid spending by around $1 trillion over the next decade.
Republicans are leveraging the shutdown to capitalize on public frustration and promise reform. Vice President JD Vance declared on Newsmax in October that “we do indeed have a plan,” referencing health care reform. (Trump has repeatedly claimed he would deliver a replacement plan for the ACA but has not followed through.)
Similarly, Senate Majority Leader John Thune stated on CNBC in October that Trump is looking to redesign the ACA to provide people with higher-quality, more affordable insurance.
The White House, however, did not respond to inquiries regarding Vance’s statements.
“Democrats are not neglecting larger reform in favor of tax credits,” noted Anthony Wright, executive director of Families USA. “The aim is to initiate discussions about healthcare. If we can prevent premium spikes, we can delve into the underlying reasons behind the exorbitant costs.”
Nonetheless, some Democrats argue that voters are feeling the pinch and demand bolder proposals now. Earlier this year, Minnesota Governor Tim Walz remarked on the podcast “Fast Politics” that the party should present more comprehensive healthcare solutions ahead of the next election.
“I can assure you, people will not expect us to simply make minor adjustments to the ACA,” he asserted. “They will demand universal healthcare.”
At least some innovative ideas are emerging in various states. Oregon, for example, has set up a governing board to create a single-payer health system, which would eliminate private insurance, premiums, and deductibles for all residents by 2027. The efficacy of this approach remains to be seen, as Vermont previously abandoned a similar initiative in 2014.
“In today’s political climate, there’s little desire for sweeping reforms. However, we recognize that these changes are necessary,” stated Mona Shah, senior director of policy and strategy at Community Catalyst, a health advocacy organization. “There is a cross-party desire for government intervention and universal coverage in healthcare. The public sentiment reflects frustrations similar to pre-ACA sentiments.”
