Four years ago, President Joe Biden set out to lower the uninsured rate and bring health security to more Americans. As the Democrat prepares to leave office, there can be no doubt that he succeeded. The White House boasted in a written statement about the latest Affordable Care Act enrollment totals:
[As a result of White House efforts,] the Biden-Harris Administration is announcing that it has set another all-time record for ACA Marketplace enrollment, with nearly 24 million Americans signing up for coverage with one week left in the 2025 Open Enrollment Period. A total of 45 million Americans have coverage through the ACA — either the Marketplace or Medicaid expansion — and more people have health insurance today than ever in our nation’s history.”
The president and his team have every reason to boast, and it’d be a mistake to see the latest good news is some kind of accident. On the contrary, as Biden’s term got underway, Democrats included generous new ACA subsidies in their American Rescue Plan — the party’s Inflation Reduction Act kept the premium assistance in place — and their efforts made “Obamacare” more affordable than ever before. Consumers noticed, and enrollment totals soared.
The results for health care advocates are worth celebrating: The Affordable Care Act is working, it’s increasingly popular, and it’s brought health security to more Americans than at any time in history.
That’s the good news. Unfortunately for health care advocates, however, there are ominous clouds on the horizon.
For one thing, Republicans are poised to have control over the White House and both chambers of Congress, and GOP leaders have been quite candid of late in condemning the nation’s current health care system. Before Election Day 2024, for example, Vice President-elect JD Vance spoke publicly about weakening protections for Americans with pre-existing conditions. Soon after, House Speaker Mike Johnson told a group of voters to expect “massive” health care changes in the U.S. once Donald Trump returns to power. “Health care reform’s going to be a big part of the agenda,” the GOP leader added.
The House speaker later claimed that he was taken out of context, but a video from the event didn’t do him any favors. When an attendee asked at the event, “No Obamacare?” Congress’ top Republican leader replied, “No Obamacare.”
Republican Sen. Mike Lee of Utah declared online soon after, “Kill Obamacare now.”
After the elections, Trump kept the party’s offensive against the ACA going, declaring on NBC’s “Meet the Press” that he believes the Affordable Care Act “stinks.” Complicating matters, the Democratic subsidies that have made ACA coverage more affordable are temporary — and they’re set to expire this year, creating what some observers have labeled a health care “time bomb.” Indeed, according to a recent Congressional Budget Office analysis, if the subsidies expire altogether, several million Americans will likely lose their coverage. As the last Congress neared its end, several Democrats tried to extend the status quo for another year, but GOP lawmakers ignored the proposal before heading home in mid-December. As for what’s likely to happen next, no one seems able to say for sure. A lobbying coalition is taking shape to push Republicans to keep premium costs low, but a variety of key GOP officials have already suggested they’re prepared to see some or all of the subsidies disappear.
Steve Benen is a producer for "The Rachel Maddow Show," the editor of MaddowBlog and an MS NOW political contributor. He's also the bestselling author of "Ministry of Truth: Democracy, Reality, and the Republicans' War on the Recent Past."
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