By Natalie Andrews
Republicans suffered through a recurring nightmare this week: their inability to replace or at least unwind the Affordable Care Act, President Barack Obama's signature healthcare program.
For the past decade, President Trump and the party have raged against the 2010 law, only to see legislative attempts to decouple it from the American economy fail. This week was no different, as a Republican proposal to replace ACA subsidies with sending federal funds directly to some households for out-of-pocket healthcare costs failed to advance in the Republican-controlled Senate.
For some Republican lawmakers, a sense of déjà vu took hold this past week amid worries that the issue might once again cost the party its political majorities.
"We run on this every time, there's not an election that comes up where we don't get beat up on healthcare," said Rep. Jen Kiggans, a Virginia Republican facing one of the most competitive races next year who has led a bipartisan effort to extend the subsidies for one year while negotiations continue.
A separate Democratic proposal to extend the enhanced Covid-era ACA subsidies for three years also failed to pass in the Senate Thursday, despite the support of four Republicans -- Sens. Lisa Murkowski and Dan Sullivan of Alaska, Susan Collins of Maine and Josh Hawley of Missouri. Combined, the failed votes increase the likelihood that millions of Americans will see their healthcare costs rise next year, during a pivotal midterm campaign season.
Democrats say they plan to make the issue a centerpiece of their effort to flip both chambers of Congress. House Republicans hold a narrow 220-213 majority, while senators hold a balance of 53-47. Sixty votes are needed to advance most legislation in the Senate.
Democrats believe increased healthcare costs next year will benefit them, noting the ACA debate comes after Republicans cut Medicaid funding in their tax bill in July.
"People are feeling the impact of their politics and decisions and they also see Republicans have no idea how to move forward," said Rep. Suzan DelBene of Washington, the chairwoman of House Democrats' campaign arm. House Democrats expanded the races they see as competitive this week, because of successful wins in elections this year in Miami, New Jersey and Virginia, and because they see strength in campaigning on this issue.
The focus on health-insurance premiums has moved the political discussion onto one of the few topics on which Democrats have an advantage. Americans' approval of the ACA edged up to a new high of 57% in December, according to a Gallup poll. An NBC poll in October found that Democrats hold a 23-point advantage among registered voters over Republicans on the party best equipped to deal with healthcare.
Democrats made voting on a bill to extend enhanced subsidies the central negotiating point in ending the record-setting government shutdown this fall, putting the issue front and center. While a group of Democrats eventually voted with Republicans to reopen the government without any concessions, they did secure the pledge from GOP leaders to hold this past week's vote.
Republicans are caught between the belief among many GOP lawmakers that markets, rather than expensive government programs, should play the leading role in providing coverage and the fact that many GOP voters have come to rely on coverage from the law, often called Obamacare.
The GOP plan for health savings accounts could help with out-of-pocket costs for people with eligible insurance plans, but it doesn't address the fundamental problem for individuals who are unable to afford insurance. It is also unlikely to be adequate for many insured people who need expensive care. Insurance plans that are paired with HSAs can be very skinny, with high deductibles, which could force some enrollees to pay more than $10,000 next year before coverage kicks in. That cost would far surpass the up to $1,500 the Republican bill would put into accounts to cover out-of-pocket expenses.
Republicans' healthcare conundrum helps explain why some GOP senators broke ranks to vote with Democrats on opening debate on extending the subsidies.
"I'm in favor of working on something, you know?," Hawley, one of the four Republicans to back the Democrats' proposal, said. "I mean, that's the only thing on offer as to premiums right now. So I think we need to work on premiums. We need to work on deductibles. And I just, I want to do something here. So you got to get started somewhere."
In the House, Kiggans has led a bipartisan effort to extend the subsidies for one year, to buy time to debate a broader solution, while other Republicans have backed her or other similar plans. Still, some in the party debated whether to even put up a counterproposal to the Democrats' measure.
Late Friday, House Republicans released a plan that included a grab bag of ideas from earlier GOP proposals, including government funding for the ACA's cost-sharing reductions for low-income enrollees and help for association health plans, which let people and small businesses band together for coverage. But it didn't continue the enhanced ACA subsidies.
Republican opposition to Obamacare still runs deep. The law, described by Republicans as government overreach, helped fuel the tea party movement and Republicans' successful effort to reclaim a House majority in 2010. Trump made it a central part of his 2016 presidential campaign. By the time Republicans had enough power in Washington to repeal the law, it had become more popular. Americans didn't want to lose protections for pre-existing conditions, or the ability to keep adult children on their insurance until age 26, key provisions of the law. Republicans came close in 2017 but failed, with then-Sen. John McCain (R., Ariz.) delivering a decisive thumb's down in one critical vote.
"Healthcare costs money and Republicans are really of the mindset and mission right now of how can we stop spending money," Kiggans said.
When it comes to the enhanced subsidies, some Republicans counter that their existence is an acknowledgment that the law has resulted in expensive plans. The average low-cost plan according to KFF is $456 a month for an individual.
"You can't put that on the Republicans," said Sen. Jim Justice (R., W.Va.). "I mean, Obamacare just is killing us, right? This isn't just a Republican deal."
Some party elders now say Republicans' best strategy might now be to avoid the issue altogether.
"Healthcare is 10 times more complicated than national security," said former House Speaker Newt Gingrich. "Republicans don't want the government more involved, they basically favor spending less, that translates into people feeling like they're being cheated."
Write to Natalie Andrews at natalie.andrews@wsj.com
(END) Dow Jones Newswires
December 12, 2025 23:00 ET (04:00 GMT)
Copyright (c) 2025 Dow Jones & Company, Inc.
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