The Healthcare Debacle

Hello, hope that your holiday season is going well.

Do you get your health insurance through the ACA Exchanges, otherwise known as Obamacare? If so, there’s a pretty high chance that your premiums are going to surge starting in January. In some extreme cases, premiums can spike more than 3 times for some payers as Covid-era subsidies are allowed to elapse.

Imagine getting that notification in January – the health insurance you’ve budgeted, say, $600 a month for instead is $1,200. Or $1,800. Or even $2,000.

That’s the reality that many Americans are going to face unless Congress pulls a rabbit out of its hat this week.

Millions of Americans, in red states and blue states alike, are going to be pissed in January. This is not like the normal increase in costs where you’re not quite sure what happened. Here, you know it was the federal government. Who are you going to blame?

The party in charge.

Republicans have been trying to find an escape route. Republican Senators’ proposal on Thursday for some of the money to go to health savings accounts got 51 votes . . . which is a fail given that you need 60 to overcome a filibuster. The Democrats’ proposal of a straightforward extension – the simplest fix – also got 51 votes because a few Republicans jumped on board, including Lisa Murkowski and Dan Sullivan of Alaska and Josh Hawley of Missouri.

The end of health insurance subsidies was contained in the Big Beautiful Bill that passed this summer on a party line vote, so Republicans own this. Democrats forced a government shutdown around this issue, which will come in handy in January. I disliked the shutdown because I thought it would cause pain and disruption without actually accomplishing anything – all the Dems got for a 43-day shutdown was a commitment to vote on healthcare, which just happened. But on the substance and the policy, I thought Republicans had made an egregious error that was going to hurt millions of families and destroy any chance they might have in the ’26 midterms.

A few Republicans have wised up to this, particularly moderate House members in vulnerable districts. As I write this, a few moderate members managed to include a vote on an extension of the subsidies attached to a Republican House plan. House Republicans expect this to fail when it’s put to a vote but I think it has a chance. There’s no guarantee though that, even if the House passes something this week, that the Senate will be able to approve the same legislation before premiums spike for the year on Jan 1. The Republican House plan is much more than just a patch on subsidies; it’s 111 pages of modifications to the healthcare industry. That will make Dems very reluctant to vote for it even if includes an extension of benefits.

Rarely have I seen such terrible policy that is going to clearly hurt 20 million-plus Americans so directly and obviously in such a short time frame. The blowback to this will be enormous.

This particular dysfunction is going to have a massive human cost, as at the margins hundreds of thousands of families will forego care. Many are going to drop their insurance coverage – that’s a terrible thing. Living without health insurance makes you very vulnerable and also stresses you out for the slightest injury or sickness. People are going to be livid. And they should be.

Our politicians have evaded accountability for years via gerrymandering and feeding their bases on culture war issues. This healthcare debacle is going to be an exception. These aren’t indigent voters who will silently get kicked aside – many of the most impacted are middle-class and up. If it doesn’t get resolved by a last-minute hail mary – and I doubt it will be – there will be hell to pay for Republicans in the New Year from their own voters. I don’t think they have any idea what’s coming. Their own base is about to turn on them. Health insurance is about as close to home as it gets for most families. 9 more of their Senators should have flipped and let the Democrats save them from themselves.

My great frustration is that people’s well-being is such an afterthought in today’s politics. We have real challenges; the people deserve a lot better leadership than this. This time, the cost is all too real.

To reform American politics, check out Forward, which is having its big year-end event tomorrow. Email matt@noblemobile.com if you want a few months off from your wireless bill and want to be rewarded with Noble Mobile. Offline’s IRL no-phones party is coming to NYC this week. My new book comes out in February as a pick-me-up; use code “UBIUBI” for 25% off. Remember to look up and touch grass for the holidays.