President Donald Trump and congressional Republicans are trying to sell the American public on their “One Big, Beautiful Bill” despite the fact many Americans, and even members in their own conference, worry about the cuts to Medicaid.
Most voters do not trust Trump on health care and fear the significant cuts to Medicaid. Republicans already face hostile voters in their town halls when it comes to health care.
But as if that were not a big enough problem, Trump and the Republicans face another looming crisis that could cause health care prices to spike.
And it comes from an old political enemy: The Affordable Care Act, Barack Obama’s signature health care law.
“I think there's going to be a lot of sticker shock of people who aren't following this debate in Congress and are going to be stunned by just how much their rates go up, because the premiums will increase substantially,” Jonathan Oberlander, a professor of social medicine at the University of North Carolina-Chapel Hill, told The Independent.
In 2022, then-Senate Majority Leader Chuck Schumer brokered a deal with now former senator Joe Manchin for the Inflation Reduction Act. As part of the agreement, the bill extended an expansion of subsidies to the Affordable Care Act that initially passed under the American Rescue Plan Act, Joe Biden’s signature piece of legislation to provide relief during the Covid-19 pandemic.
Under the Affordable Care Act, also known as Obamacare, people who might not have health insurance under their employer but are not eligible for Medicaid can purchase health care on state exchanges. If they earn an income below a certain threshold, they could be eligible for tax credits.
“They might not get employer-sponsored health care, but they're like realtors or entrepreneurs or small business owners or Uber drivers,” one former Capitol Hill aide who now works in health care told The Independent. “These folks – going to the exchanges trying to purchase their health insurance, they're on the precipice of seeing a big cost of living increase.”
The subsidies initially passed under the ARPA, and then later under the IRA, increased eligibility for people making up to 400 percent of the Federal Poverty Line. But they expire at the end of the calendar year.
Oberlander said it could create a cost crisis.
“It's going to affect people in the sense that the pool will become smaller, and therefore, depending on who leaves, because it depends – the people are leaving healthier or sicker than the average, it can destabilize the pools to some extent.” he said.
“And people are going to read about it and see it, and they're going to feel it and they're going to pay it, and I think there would be a lot of anger.”
Sen. Thom Tillis (R-N.C.), who will not seek re-election in 2026, said Republicans could extend the package, specifically in a year-end spending package.
“I've got to believe that that may become a discussion and the year end appropriations, at least some sort of a short term extension, so they can sort it out,” he told The Independent last week before recess.
The government runs out of funding for the fiscal year at the end of September. Open enrollment for the health insurance marketplaces typically begins in November.
But Democrats are not as confident.
“Here we are trying to fix all the things that they broke,” Sen. Tina Smith (D-Minn.) told The Independent. “You've got Republican senators introducing bills to undo the things that they just passed.”
There’s evidence this could have massive consequences for patients. In December 2024, the nonpartisan Congressional Budget Office warned that 2.2 million Americans could lose their health insurance by 2026 if the extended subsidies expired. It also warned that 3.7 million people could lose coverage by 2027.
Still, some Republicans said that they do not want to make a fix.
“Obamacare is doing so much damage to our healthcare system, to our federal budget, I don't want to renew any part of it. quite honestly,” Sen. Ron Johnson (R-Wisc.) told The Independent. “We need to repair the damage done by Obamacare.”
But Trump might not have a choice. Polling shows that health care is one of the few policies where voters still trust Democrats more than Republicans.
“This is not the same ACA that he ran against in 2016, it covers many more people, both through Medicaid and in the marketplace,” Oberlander said.
“It's much more popular than it was, and if his administration and congressional Republicans are seen as gutting the health insurance marketplaces and raising people's millions of people's premiums, that's bad politics, and it's bad politics at a time when he already has a fairly low approval rating.”
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