In January, when President Donald Trump unveiled his one-page outline to address health care spending, dubbed “The Great Healthcare Plan,” he specifically mentioned the Affordable Care Act’s role in driving up costs.
“I call it the unaffordable care act,” he said. He reprised the line in his 2026 State of the Union address, blaming “the crushing cost of health care” on Obamacare.
Trump’s words also play off an ongoing congressional debate that began late last year with the expiration of the enhanced tax subsidies that had lowered the cost of ACA insurance for millions of Americans — and thrust the issue of ACA-related costs back to center stage.
Without those enhanced subsidies, the amount people pay toward monthly Obamacare premiums doubled, on average. The number of people enrolled in ACA coverage for this year has dropped by more than a million, and experts say more people could abandon coverage once premiums come due. Democrats are using this development to crank up the heat on Republicans ahead of the November elections and steer the conversation on the affordability issue.
Republicans fault the law itself for driving up these costs. For instance, Rep. Mike Lawler (R-N.Y.) has said that premiums “skyrocketed across the country since it took effect.”
Critics routinely point to several provisions within the ACA as the culprits — among them, essential health benefits, or EHBs. Under the law, Obamacare plans must cover certain essential services, including emergency care, hospitalization, maternity, and prescription drugs, without an …