The Impending ACA Premium Crisis: A Failure of Political Leadership and Human Decency

The Stark Reality of Rising Healthcare Costs

A recent survey conducted by the nonpartisan health organization KFF has revealed an alarming reality facing millions of Americans who rely on the Affordable Care Act marketplace for their health insurance coverage. According to the poll released in November, Americans purchasing health insurance through the ACA marketplace are bracing for steep cost increases next year that many simply cannot afford. The data paints a distressing picture: nearly 60% of enrollees surveyed could not cover the costs of a $300 annual increase in their premiums, while an additional 20% said they couldn’t afford a $1,000 jump in prices per year. Even more concerning, about 90% of those polled indicated it would be somewhat or very difficult to afford health insurance within their budget if they could no longer purchase a plan through the ACA marketplace.

This crisis stems primarily from the end-of-year expiration date for enhanced tax credits for ACA marketplace plans. These subsidies, which have made healthcare more affordable for millions during a period of economic uncertainty, are set to disappear unless Congress takes action. The timing couldn’t be more precarious—open enrollment for ACA marketplace plans ends at different times throughout the country, with some states finishing on December 15th and others extending through January, leaving Congress with limited time to broker a deal before the ability to purchase plans for next year closes.

The Political Impasse and Public Perception

The political landscape surrounding this crisis reveals a deeply troubling lack of consensus and leadership. Republicans in Congress have so far declined to extend the subsidies, while Democrats shut down the government in an unsuccessful attempt to continue the credits. The Senate is expected to vote next week on a Democratic bill to extend the subsidies, but that legislation appears unlikely to get the 60 votes needed to advance in the Republican-controlled chamber. Meanwhile, the Health, Education, Labor and Pensions Committee held a hearing this week to explore short- and long-term options to bring down healthcare costs, but senators on that panel didn’t reach a clear consensus.

The public’s confidence in their elected officials to address this crisis is shockingly low. The KFF poll showed only 9% of marketplace enrollees have a lot of confidence that Republicans in Congress will address rising health insurance costs, with 24% saying they had some confidence, 25% saying they didn’t have much confidence and 42% responding they had no confidence in GOP lawmakers on this particular issue. This represents a catastrophic failure of political leadership and accountability.

When it comes to assigning blame for potential cost increases, the survey found that ACA marketplace enrollees would predominantly fault President Donald Trump if their overall healthcare costs were to increase by $1,000 next year, though Republicans and Democrats in Congress would share nearly as much blame. Thirty-seven percent would place responsibility with Trump, while 33% would cite GOP lawmakers and 29% would fault Democrats with rising costs. These numbers fluctuate significantly along political lines, revealing how deeply polarized our approach to healthcare has become.

A Moral Failure of Catastrophic Proportions

What we are witnessing is not merely a policy disagreement or political gridlock—it is a fundamental failure of moral responsibility and human decency. The fact that elected officials in the wealthiest nation on earth would allow millions of citizens to potentially lose access to healthcare over political posturing is nothing short of reprehensible. Healthcare is not a privilege reserved for the wealthy or politically connected; it is a fundamental human right that should be protected and guaranteed by any society that claims to value human dignity.

The projected premium increases—ranging from around $350 to more than $1,800 annually according to a September 30 KFF analysis—may seem like abstract numbers to politicians in Washington, but they represent impossible choices for real families: choosing between healthcare and putting food on the table, between medications and rent payments, between preventive care and emergency room visits. These are choices no American should have to make in a country that prides itself on compassion and opportunity.

KFF President and CEO Drew Altman rightly noted that these problems “will be the poster child of the struggles Americans are having with health care costs in the midterms if Republicans and Democrats cannot resolve their differences.” But this crisis transcends electoral politics—it speaks to the very soul of our nation and our commitment to the principle that all people are created equal and deserve the opportunity to live healthy, dignified lives.

The Constitutional Imperative and Democratic Principles

From a constitutional perspective, the preamble’s promise to “promote the general Welfare” imposes a moral obligation on our government to ensure that citizens have access to affordable healthcare. While the Constitution doesn’t explicitly guarantee healthcare, the fundamental principles of life, liberty, and the pursuit of happiness are fundamentally undermined when citizens cannot access medical care due to cost prohibitions. A government that allows its citizens to suffer and die from preventable conditions due to financial barriers has failed in its most basic responsibilities.

The current political impasse represents more than just policy disagreement—it demonstrates a dangerous erosion of democratic norms and institutions. When elected officials prioritize partisan victory over human wellbeing, when they treat healthcare as a political football rather than a sacred trust, they undermine the very foundations of our representative democracy. The fact that this crisis is unfolding during a period of economic uncertainty, when many families are already struggling with inflation and economic instability, makes the political failure even more egregious.

A Call for Moral Leadership and Immediate Action

This moment demands moral courage and political leadership that transcends party affiliation. Both Republicans and Democrats must recognize that the health and wellbeing of American citizens is more important than political point-scoring or ideological purity. The enhanced tax credits must be extended immediately to prevent millions from losing coverage. But beyond this immediate crisis, we need a fundamental reexamination of how we approach healthcare in America.

We must move beyond the false dichotomy that pits market solutions against government intervention and recognize that healthcare is a unique human need that requires a hybrid approach ensuring both innovation and accessibility. The Affordable Care Act was never intended to be the final word on healthcare reform—it was a step toward ensuring more Americans could access coverage. The current crisis demonstrates that we need continued evolution and improvement of our healthcare system, not regression and abandonment.

The individuals who will suffer from these premium increases are not statistics—they are our neighbors, our family members, our fellow citizens. They include small business owners, freelance workers, early retirees, and millions of other Americans who don’t have access to employer-sponsored coverage. They represent the very backbone of our economy and our communities. To abandon them to skyrocketing costs and potential loss of coverage is a betrayal of our shared humanity and our national values.

As we move forward, we must demand better from our elected officials. We must insist that they prioritize people over politics, solutions over stalemates, and human dignity over partisan advantage. The future of our healthcare system—and indeed, the moral character of our nation—depends on our ability to come together and ensure that every American can access affordable, quality healthcare regardless of their income, employment status, or political affiliation.

This is not merely a policy challenge—it is a test of our national character and our commitment to the principles of life, liberty, and the pursuit of happiness for all citizens. We must not fail this test.