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insurance premiums
Trump Healthcare Payment Proposal Sparks Fresh Medicare for All Demands to Fix ‘Broken’ Healthcare System
“These subsidies have to get bigger and bigger and bigger to keep the ACA affordable,” said US Senate candidate Dr. Abdul El-Sayed. “The fight for healthcare right now can’t end with ACA subsidies. It has to be bigger.”
Nov 10, 2025
As the government appears poised to reopen, with Republicans having successfully avoided concessions on their goal of eliminating Affordable Care Act tax credits, President Donald Trump has proposed his own solution to the looming explosion in health insurance costs.
By agreeing to reopen the government without a deal, Democrats have given up their main leverage to force Republicans to extend the credits set to expire at the end of the year. If this happens, over 22 million Americans are expected to see their monthly insurance premiums more than double. As enrollment data for next year shows, Americans are already seeing skyrocketing healthcare costs, not just for ACA recipients but for everyone.
While Republicans successfully strong-armed their opposition into caving by using the shutdown to turn the screws on government workers and food stamp recipients, they still have to weather the political fallout of the coming healthcare apocalypse. A poll released Thursday by KFF found that 74% of Americans—half of whom are self-identified Republicans—want to see the credits extended. Three-quarters also say they'd blame either Trump or Republicans in Congress if they weren't.
On Truth Social Saturday, as a shutdown deal appeared likely, Trump proposed his own idea:
I am recommending to Senate Republicans that the Hundreds of Billions of Dollars currently being sent to money sucking Insurance Companies in order to save the bad Healthcare provided by ObamaCare, BE SENT DIRECTLY TO THE PEOPLE SO THAT THEY CAN PURCHASE THEIR OWN, MUCH BETTER, HEALTHCARE, and have money left over. In other words, take from the BIG, BAD Insurance Companies, give it to the people, and terminate, per Dollar spent, the worst Healthcare anywhere in the World, ObamaCare.
Trump is correct that under the current scheme, Americans don't actually receive money directly. But experts warn that while there’s a visceral populist logic to his proposal, the flaws of replacing those annual subsidies with a one-time payment become obvious with the barest of scrutiny, especially when it is paired with a proposal to fully repeal the ACA.
"You have to read between the lines here to imagine what President Trump is proposing," said Larry Levitt, the executive vice president for health policy at KFF. "It sounds like it could be a plan for health accounts that could be used for insurance that doesn’t cover preexisting conditions, which could create a death spiral in ACA plans that do."
One of the Senate's most prominent proponents of eliminating the ACA and other parts of the social safety net, Sen. Rick Scott (R-Fla.), said he was "writing the bill right now," and clarified that it would indeed involve "HSA-style accounts" for Americans in place of subsidized insurance.
On Sunday, Sen. Adam Schiff (D-Calif.) noted that this was just a reheating of the "same old, tired proposal of repealing the Affordable Care Act, giving people a benefit in the form of a health savings account, but allowing insurance companies once again to cancel policies and refuse to write policies for people who have preexisting health conditions."
HSAs were a key component of the Republicans' failed 2017 plan to "repeal and replace" the ACA, which many critics pointed out would allow insurers to skyrocket the costs of insurance for those dealing with preexisting conditions.
Sen. Chris Murphy (D-Conn.), who sits on the Senate Committee on Health, Education, Labor, and Pensions (HELP), called Trump's new plan "unsurprisingly nonsensical."
"Is he suggesting eliminating health insurance and giving people a few thousand dollars instead?" Murphy asked. "And then when they get a cancer diagnosis, they just go bankrupt?"
But while many Democrats decried yet another effort to dismantle the ACA, some progressives pointed out that health insurance costs, and healthcare costs more generally, have still exploded under Obamacare, which—despite introducing new guardrails—still leaves profit-driven insurance intact and requires all Americans to purchase it.
"Yes, Mr. President: You’re right. We do have 'the worst healthcare' of any major country," replied Sen. Bernie Sanders (I-Vt.), the HELP committee's ranking member, who has long decried the profiteering of insurance companies. "Despite spending twice as much per capita, we are the only major country not to guarantee health care to all as a human right. The solution: Medicare for All."
He was joined by Rep. Ro Khanna (D-Calif.), who ripped Trump's plan on Fox News.
"Healthcare premiums... they are going to spike about 100% in some cases," Khanna said. "Now, if you take the tax credits and you just give them to the American people, who is the president expecting them to buy the plans from? Is he expecting them to get junk insurance?"
"I agree with him that the system is broken," he continued. "And we should be expanding Medicare to have Medicare for All. But in the meantime, we've got to give people help so that their premiums don't spike."
On social media, Khanna pointed to a 2020 analysis by the nonpartisan Congressional Budget Office (CBO), which found that the US would spend about $650 billion less on healthcare per year in 2030 if it adopted Medicare for All because it would drastically reduce the administrative waste and non-healthcare-related spending inherent to private insurance. It would also allow the government to use its massive leverage as America's primary insurer to negotiate dramatic price reductions for drugs and medical services.
Those arguments have also been made by Dr. Abdul El-Sayed, a long-time Medicare for All proponent who is running for the open Senate seat in Michigan in 2026. He explained to a crowd that the fact that Republicans "can muck around with subsidies" in the first place is evidence of a broader healthcare crisis that stems from the preeminence of privatized healthcare.
"The very fact that we're watching as these subsidies have to get bigger and bigger and bigger to keep the ACA affordable, the very fact that we're relying on Medicaid to be expanded, that, to me, is the reason why in a moment like this, it's not enough just to protect what we have," he said.
He continued on social media: "The fight for healthcare right now can’t end with ACA subsidies. It has to be bigger. Too many Americans are suffering over medical debt and spiraling costs. It should be nothing short of Medicare for All."
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Dems Say They'll Stand Firm Against Budget Deal Unless GOP Halts Attack on Healthcare
Health insurance premiums are expected to rise significantly for approximately 22 million Americans after Republicans ended a tax credit for those enrolled in programs under the Affordable Care Act.
Sep 11, 2025
Democratic leaders said Thursday that they plan to hold up negotiations on a potential government shutdown unless Republicans agree to forfeit a policy change that is expected to dramatically raise health insurance premiums for millions of Americans.
Health insurance premiums are expected to rise significantly for approximately 22 million Americans enrolled in Affordable Care Act (ACA) marketplace plans after Republicans refused to extend enhanced tax credits when passing Trump's "One Big Beautiful Bill Act" in July.
In remarks on Capitol Hill Thursday, Senate Minority Leader Chuck Schumer (D-N.Y.) said he and Democratic House Leader Hakeem Jeffries (N.Y.) were in total agreement not to negotiate unless Republicans agree to extend the tax credits.
“On this issue, we’re totally united. The Republicans have to come to meet with us in a true bipartisan negotiation to satisfy the American people’s needs on healthcare, or they won't get our votes, plain and simple,” Schumer warned at a press conference.
"We will not support a partisan spending agreement that continues to rip away healthcare from the American people. Period. Full stop,” Jeffries said.
The enhanced tax credits, which were created in 2021 under the American Rescue Plan Act and later extended through the Inflation Reduction Act in 2022, are credited with reducing the insurance premiums of millions of people who purchase health insurance through government exchanges.
The tax credits have reduced insurance premiums by 44% on average—over $700 per enrollee—and have contributed to the number of people purchasing insurance on the exchanges more than doubling to over 24 million in 2025.
According to a report released Wednesday by KFF:
Nine in 10 enrollees (92%) receive some amount of premium tax credit. If these enhanced tax credits expire at the end of 2025, out-of-pocket premiums would rise by over 75% on average for the vast majority of individuals and families buying coverage through the Affordable Care Act (ACA) Marketplaces.
The increases come as insurance companies, citing "slumping share prices," per the Financial Times, are planning the largest hike to premiums in 15 years, including an 18% increase for those buying from ACA exchanges.
These increases will come on top of those already expected as a result of a Trump administration rule passed in June, which increased the maximum percentages of income and raw dollar amounts that insurance plans could charge patients out-of-pocket for care.
According to the Center for Budget and Policy Priorities, these changes "will make coverage less affordable for millions of people." The CBPP estimates that "a family of four making $85,000 will have to pay an additional $197 in premiums for coverage in 2026" while a "family of two or more people on the same plan could face an additional $900 in medical bills if a family member is seriously ill or injured in 2026, and an individual enrolled in self-only coverage could face an additional $450 in medical bills."
In all, the Congressional Budget Office estimated in May that as a result of these mounting costs, over 5 million people will no longer be able to afford their health insurance plans.
"The death star of American healthcare, the insurance companies are preparing to blow up the lives of millions of middle-class families," warned journalist David Sirota in a podcast for The Lever.
Republicans in Congress are facing mounting pressure to extend the tax credits and stave off the premium hikes. Last week, 11 Republicans in Congress signed onto a bill that would extend the credits through 2026, allowing them to avoid the issue until after the midterm elections.
A survey conducted in July by two of Trump's most trusted pollsters, Tony Fabrizio and Bob Ward, found that for Republicans in the most competitive districts, "a 3-point deficit becomes a 15-point deficit" against the generic Democrat if they allow the healthcare premium tax credit to expire.
House Speaker Mike Johnson (R-La.) has stayed coy about whether he and the Republican caucus plan to support extending the credits.
"I'm not going to forecast that right now," Johnson told reporters earlier this week, while also saying, "There's a lot of opposition to it as well."
Democrats, meanwhile, have proposed a competing bill to make the subsidies permanent and are hoping to use this month's budget showdown to force Republicans to make concessions on the issue.
As David Dayen wrote Monday for the American Prospect, it sets up a challenging strategic and moral dilemma for Democrats:
On the one hand, Democrats fighting for healthcare benefits speaks to an issue where they have the highest level of support from the public. They would credibly be able to tell voters that they fought for lower costs during an affordability crisis and won, and that more of that will happen if they are given power in the midterms.
On the other hand, Republicans willingly drove the healthcare system toward the point of oblivion, and some may question why Democrats would offer a lifeline to bail them out. In this reading, relieving Republicans of the consequences of their health care plans would be harmful to Democratic midterm chances; Trump would take credit for keeping health care costs low.
What's clear, Dayen said, is that "unless action is taken, it will be an enormous example of Trump's failure to rein in the runaway cost of living."
Lisa Gilbert, co-president of Public Citizen, urged Democrats to stand firm as the fight over a potential government shutdown heats up.
"If Republicans refuse to negotiate and move away from their cost-increasing agenda, then it is Republicans who will be forcing a government-wide shutdown," Gilbert said. "There should be no deal without assurances that the budget will be honored and not impounded, and one that returns care to the American people.”
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