I just turned 26, which means I was unceremoniously booted off my parent’s health insurance and had to fend for myself in the wild west of American health care. For a freelancer like me, this meant I had to buy health care on the marketplace.
First, I had to figure out what that even is.
Let’s go back to 2010, when I was a small child who didn’t have to worry about understanding the word “deductible.” That year, Congress passed the Affordable Care Act, colloquially known as Obamacare. The law established marketplaces where people could buy health insurance if they didn’t get it through work, Medicare or Medicaid. It also gave tax credits—or a dollar amount you subtract from how much taxes you pay—to lots of people who got insurance this way.
By 2014, those marketplaces were up and running. That year alone, over 5.4 million people saved an average of $276 per month thanks to the credits, according to data from the Centers for Medicare & Medicaid Services.
Then in 2021, Congress poured a lot more funding into these tax credits. They increased the tax credits that enrollees got and made more enrollees eligible. From 2021 to 2025, the total annual premium tax credits that Marketplace enrollees received went up by about $87 billion, and the number of Americans getting these tax credits went up by about 12 million.
The catch? Those enhanced tax credits were only extended through the end of 2025. As Congress negotiated budget legislation to stop the government from shutting down during September, voters pressured Democrats to fund health care and stand up to Republican lawmakers aiming to gut health care spending. So, Democrats insisted that they would only vote for budget legislation if it included funding for these ACA tax credits. Republicans refused, and the government shut down.
It was the longest shutdown in history and it looked like Democrats really were not going to back down until we got extended tax credits. But then, they did— to everyone’s dismay, which I covered live here. The Democrats agreed to open the government for the promise of a vote on ACA subsidies.
So basically, we are exactly where we were: on the cusp of a lot of people losing health insurance. Or, having to pay for much more expensive insurance. How much more expensive? I did the math.
At the heart of these price hikes is a standoff between lawmakers over funding tax credits that help people pay for Obamacare coverage. Basically: Democratic lawmakers want to fund those tax credits; Republican lawmakers don’t. (Along with a whole lot of shutdown shenanigans that have once again punted a vote over the matter to December.) Without relief, nearly 22 million people who get those credits can expect to pay more.
Think you’re safe if you weren’t getting these tax credits anyway? Think again! Insurers that are part of Affordable Care Act Marketplaces (i.e. where you buy health insurance through Obamacare) proposed a median premium increase of 18 percent—about 11 percentage points higher than last year’s median. And think you’re safe because you get health insurance through your job? Also, think again! Next year is expected to see the highest increase in the total health benefit cost per employee since 2010. In other words, more money is gonna come out of your paycheck to pay for your health insurance—about 6 to 7 percent more on average.
But how much more you’ll be paying depends on factors like your age, where you live, and whether you’re married. I don’t know you like that, so enough about you. Let’s talk about me. I’m an unmarried 26-year-old living in Illinois. Here, insurers have requested rate changes as high as 38 percent. That kind of increase to my current premium would have me paying over $430 per month for health insurance. That’s roughly the same as my grocery budget, about a third of my rent, more than four times my utilities, and it would force me to choose between buying the occasional little treat out or saving enough to retire in this lifetime.
This got me thinking about how Republicans convinced anyone that getting rid of these subsidies was a good idea in the first place. I decided to do some decoding.
Why say “medicaid reforms” when trying to kick people off of Medicaid? Why did GOP lawmakers insist they couldn’t negotiate over health care if the government was shut down? Why lie about federal spending on undocumented people’s health care?
To understand, I turned to an unlikely source: my high school English notes on ‘Language in Thought and Action’ by S.I. Hayakawa. The book can help answer: Why do politicians sound like that?
Take House Speaker Mike Johnson. After the government shut down, he discussed “Medicaid reforms, not cuts.” Then he clarified what reforms he had in mind: “Kick those people off,” he said of groups that he believed to be improperly enrolled. The difference is a matter of semantics, or more specifically, what Hayakawa calls “affective connotation.” That’s our personal feelings attached to language. After all, if 74 percent of surveyed Republicans approved of Medicaid (per a June KFF poll), wouldn’t you—a GOP politician—avoid admitting to cutting it?
Next, take JD Vance lying about Democrats demanding “billions of dollars” for undocumented people’s health care. Even if we put aside the cruel implication that undocumented people don’t deserve affordable health care, the claim isn’t true. But pitting undocumented people against other Americans reinforces what Hayakawa calls the two-valued orientation—an “us vs. them” mentality that politicians use to mobilize their base.
Lastly, take Senate Majority Leader John Thune’s vague statements about needing to reopen the government. What does that mean, actually, and how did he want to get there? This is another rhetorical device Hayakawa calls “abstraction.” We all do it to streamline conversation. But we can also use it to point fingers or absolve ourselves of blame, like talking about reopening the government without specifying how one might—or might not—do that. So next time you’re listening to politicians use maddeningly euphemistic terms to describe real people’s future pain, don’t be outwitted by tactics basic enough to be taught in high school.
But are people buying it? I sought out Americans across the political spectrum to see their thoughts on the changes to the ACA.
Some conversations went so in-depth I had to make videos just devoted to them. You can watch all seven videos here.
Now what? I have some final reflections:
First, discontent with political leaders is running high. When the government shut down, affordable health care was at the center of lawmakers’ fight over funding the government. Democrats wanted any funding legislation to include an extension of tax credits for people on Affordable Care Act marketplace plans. Republicans refused. Then, a group of Senate Democrats broke ranks to reopen the government without extending the credits. People who’ve voted Republican before have shown frustration with GOP leaders for their refusal to extend the credits, and liberals and leftists alike have derided the Democrats who didn’t hold the line after the country endured the longest government shutdown in US history.
Second, the credits expiring will have widespread impacts. Although the millions of Americans receiving the credits now will be most directly impacted, others will feel ripple effects. Private insurance is set to get more expensive, and other people not receiving the subsidies also face higher costs and more limited coverage.
Third, in addition to the massive humanitarian toll that limiting access to affordable health care will take, the economy will also suffer. Many small business owners—people who Senate Majority Leader John Thune, a Republican, have called “the backbone of our economy”—expressed fear and anxiety over the rising costs of their marketplace plans as their subsidies are set to expire.
Oh, and last week, Republicans blocked yet another ACA vote.
