https://www.washingtonpost.com/opinions/2025/11/01/health-care-subsidies-aca-obamacare-exchanges/ Opinion Editorial Board The unaffordability of Obamacare comes home to roost ACA subsidies are a Band-Aid for a fundamentally broken health care system. November 1, 2025 at 9:09 a.m. EDT Today at 9:09 a.m. EDT Millions of families face sticker shock this weekend as open enrollment begins. The amount health insurers are charging for coverage on Affordable Care Act marketplaces is rising 26 percent on average. That’s not so affordable. Of the 24 million people currently enrolled in one of those plans, 22 million receive government subsidies to defray the costs. If tax credits enacted during the pandemic are allowed to expire at the end of this year, these currently subsidized enrollees would see their monthly premium payments more than double on average, according to estimates by the nonprofit KFF. Democrats took the government hostage and forced the partial shutdown a month ago with the stated rationale of compelling Republicans to extend these subsidies. The Congressional Budget Office and the Joint Committee on Taxation estimate that would cost $350 billion over the next 10 years. Clamoring to indefinitely extend what was promised as a “temporary” fix is a perennial storyline that helps explain how the U.S. health care system became so complicated and costly. The late economist Milton Friedman said nothing is as permanent as a “temporary” government program. For 80 years, the health system has been warped by a decision during World War II to exempt employer-sponsored health insurance from wage and price controls. Employers used health benefits in lieu of wages to attract and retain workers. That’s how insurance started to become a standard feature of employment. That distortion was amplified by a 1954 law clarifying that health benefits, unlike salaries, are not taxable to the employee. As a result, employers funneled more compensation into health care, because a dollar of extra insurance went further than a dollar of added wages. Those decisions have outsize consequences today. The system is now fragmented into a patchwork of tax-subsidized, employer-sponsored plans, and another patchwork of programs that fill the gaps between them. This complexity creates perverse incentives and inefficient cross subsidies, burdens patients and providers with excessive paperwork and disrupts the continuity of care. The system is stupid, but political professionals fear backlash if they try to rebuild it along more rational lines. Frustrating as it is, the majority of Americans are quite satisfied with their current coverage and would be leery of giving it up for some untested scheme — particularly if that would require massive new taxes, as Medicare-for-all would. Obamacare’s design reflected that political reality. Rather than attempting wholesale reform, it grafted more patchwork systems onto the existing patches. A three-legged stool of regulations, insurance mandates and subsidies aimed to move the uninsured into exchange policies or Medicaid without disrupting too many existing plans. There were some valiant efforts to curb the system’s cost problems, such as a board to evaluate the cost-effectiveness of treatments and a tax on especially generous insurance policies. But these proved ineffective and politically unworkable. The ACA exchanges also didn’t work. The mandate was copied from European systems in which hefty penalties forced people to buy insurance, but the American version was defanged to make it more palatable. In 2010, the Congressional Budget Office projected that 21 million people would buy exchange policies in 2016. The actual number was 12.7 million. In 2017, Republicans effectively repealed the mandate entirely. Because the mandate was so weak to begin with, this made less difference than many expected, but the number of people buying exchange policies still declined slowly. Democrats could have tried to reimpose a real mandate when they regained power in 2021, but they found it more politically expedient to just massively boost the subsidies, including offering them to families that made 400 percent of the federal poverty line. They did so under the guise of pandemic exigencies. This had an electric effect on the exchanges, which saw enrollment more than double between 2019 and 2025. The lavish subsidies increased demand for health care while failing to increase the supply. Inevitably, this raised total costs. And now the bill is coming due. It doesn’t need to be this way. Artificial intelligence can drive down costs. So would expanding competition via deregulation. A system that emphasized high-deductible catastrophic plans could give consumers more responsibility — and choices — about routine expenses. The solution offered by Democratic leaders is to keep shoveling more taxpayer money into a pit of ever-larger subsidies, even though the national debt is $38 trillion and growing. Republicans, who have never gotten serious about developing a viable alternative to Obamacare, lack the political will to stop this giveaway, because so many of their own voters have grown habituated to the entitlement. Lawmakers are already thinking about the 2026 midterms and still feel burned by their failed ACA repeal efforts a decade ago, which proved costly in 2018. The likeliest outcome is some kind of compromise that lets a broken system stagger on, in a permanent state of temporary crises.
You posted zero negative OPeds about trump bailing out Argentina for 40 billion which well never see back again. Spending that same 40 billion on Healthcare for 24 million people though is dumb because the system isn't prefect. Got unlimited money for regime change but none for Healthcare Its funny anyone thought you were anything other than a MAGA boomer
The article is right though. The ACA is expensive because our health care model is wildly overpriced. But the other models that keep costs low and have high health scores are socialized and the models that keep costs low and have low health scores are fully privatized. Neither model is optimal. America as a country is ****ed demographically. Our populace smokes, drinks, does not exercise, does drugs, and eats way too much processed food. In part because our time is spent keeping the US economy moving at all costs and to curb any of that is an affront to our FREEDOM. We are a leisure seeking society killing ourselves to keep ahead. But because we refuse to have a socialized health care program (and those are with major problems on their own) and be a globalized military superpower, I support the government being involved in the semi private health care model we have hobbled together.
Aca sucks cuz congress is broken and we have unlimited money flowing into our politics. Aca was a brokered deal with centrists in the south when Obama was potus. We needed a public option which is the better option. The point being is as bad as the ACA is the alternative is worst cuz Trump has no plan. Kicking tens of millions of people off healthcare is bad
This completely ignores the issue. If we could go back to pre ACA yes that may be the best issue, because insurance companies have since exploded and taken the lionshare of the total budget the issue is that americans are getting taxed and robbed at a socialist level bracket with 40%-50% taxes and they still aren't getting any of the benefits. The tax dollars have already been given, but it is being redistributed into the oligarchy. This is the most openly corrupt government that has existed.
replace "Obamcare" with tax cuts for the uber rich, top 1% subsidies for farmers, infrastructure, etc
there really needs to be a secession and 2 different countries formed this just isn’t sustainable any longer
I don't care for the leeches in red states or blue states, urban communities or rural communities, left-handed or right-handed, or any other distinction unrelated to me being forced to pay their way. I know, it's awesome. I hope the government never reopens. Makes no difference to me what color they are, I care that they are stealing from me.
You are a pompous greedy and selfish man calling people who don't get paid enough to buy food for their family, people who have lost their jobs, and people who may have worked and payed taxes their whole life leeches. Men like you disgust me.
I’m hearing that Walmart is preparing to close inner city stores (online sales only) if SNAP isn’t restored. Expecting unrest and rampant theft. Suburban stores should be fine.
This is one of the key reasons why I was against the ACA - It never tackled the real unnecessary costs. Private insurance benefits with increased costs. The government was willing to subsidize some of the most unhealthiest population in the country, much of it preventable. Any idiot could see the ACA would break eventually. While a decade too late, there is a new problem that is becoming increasingly serious, and that is quality health care. Gen X'ers going to wake up one day and find out there is a massive doctor shortage.
he takes a sh*t on his MAGAt followers daily, and they eat it all up thanking their daddy for the meal
