Medicaid for millions, misery for the middle class

For months, Republicans and Democrats alike have insisted on keeping the Medicaid subsidy scam alive — even as it drives inflation and enriches the health care cartel. With the Biden-era expansion of Obamacare “marketplace” subsidies set to expire in December, both parties want to renew them. But this moment offers Republicans a rare opportunity: Finally lower health care costs for Americans not living on government handouts.

Obamacare buried the middle class

The ill-named Affordable Care Act helped Republicans win more elections than any issue in recent memory. But since 2016, the party has run from the fight. The result: Individual plans became unaffordable for anyone not getting subsidies, and employer-based coverage got gutted. Workers earn less in take-home pay and pay more for thinner plans.

The signature feature of Obamacare was turning catastrophic coverage into a luxury item.

Rather than continually shielding consumers from Obamacare’s price hikes with subsidies, why not repeal the mandates that caused the pain in the first place?

The numbers speak for themselves. In 2013, just before Obamacare took full effect, the average unsubsidized premium for individual coverage was $197 per month. By 2017, it had nearly doubled to $393. Family plans saw a 140% jump in that same period, from $426 to $1,021. Today, a typical family policy without subsidies costs $2,000 to $2,500 per month.

According to the Kaiser Family Foundation, average family premiums climbed from $13,770 in 2010 to $25,572 in 2024 — an 85% increase. And that “Cadillac plan” price tag now buys you higher deductibles and fewer benefits than a cheap pre-Obamacare policy.

Younger workers don’t even know what hit them. They’ve inherited a system designed to fleece them and can’t afford to opt out.

Even employer-based insurance has suffered. Since 2014, family premiums have risen 52%, while workers’ share has jumped 31%. Deductibles for individual plans have increased 53%, reaching $1,787 in 2024. Americans now pay more out of pocket for less protection.

This wasn’t an accident. It was baked into the law. Obamacare banned insurers from pricing plans based on risk, age, or gender. That shifted costs from older, sicker Americans to younger, healthier ones. Those who don’t qualify for subsidies pay top dollar for a bloated, mandatory benefits package they didn’t ask for.

Meanwhile, over 70 million lower-income Americans got dumped onto Medicaid — and Republicans went along with it. If Medicaid expansion is the new baseline, then at least fix the rest of the system for the middle class.

Caught in the middle

The political class loves to talk about the millions who gained “coverage” through Medicaid expansion and premium tax credits. They ignore the millions who earn too much to qualify for substantial assistance but too little to afford the staggering premiums.

These Americans are Obamacare’s silent victims — and they’re forced to choose between health coverage and other basic needs.

Subsidies don’t solve the problem. They mask it. The real crisis is the cost of health care itself.

Republicans already get hammered for supposedly “cutting Medicaid,” even when they’re only targeting fraud. They pay the political price for Obamacare without reaping any of the reform benefits. So why not go on offense and start dismantling the cartel?

Demand real reform

Instead of rubber-stamping another round of subsidies, Republicans should demand one simple trade-off: Let states offer unregulated, cheaper health care plans.

Don’t extend subsidies for the wealthy or the idle. And if temporary subsidies are unavoidable, they should be tied to an overhaul next year.

The signature feature of Obamacare was turning catastrophic coverage into a luxury item. Letting states revive affordable catastrophic plans would free up cash for direct primary care — and crack the cartel’s grip on pricing.

RELATED: Pushing back against the big Medicaid lie

  Yurii Karvatskyi via iStock/Getty Images

And that’s just the beginning. Congress should allow health savings accounts, self-employment deductions, and employer exclusions to apply to alternative options like health-sharing ministries and concierge care. Workers should be able to use HSA funds to pay their own premiums or direct care memberships.

Employers should receive the same tax benefits for contributing to an employee’s HSA as they would for funding a traditional insurance plan. That gives workers real purchasing power and puts pressure on the cartel to compete.

Break the cartel. Rebuild the market.

Even if Republicans won’t fully repeal Obamacare, they must scrap the ban on physician-owned hospitals. That carve-out handed a monopoly to corporate health systems and helped bankrupt rural hospitals — a crisis both parties now pretend to solve with more subsidies.

You can’t subsidize your way out of a bottomless pit of inflationary grift. The only real solution is to let Americans escape the sinkhole that turned affordable health care into unaffordable sick care.

This is the GOP’s last chance to fix what it failed to kill. Make it count.