The debate over affordability is now truly and fully joined.

After the off-year elections, Democrats are coalescing around a cost-of-living message that makes more sense than their anti-Trump obsessions (not that we aren’t going to hear a lot about those). For its part, the White House has concluded that affordability is a vulnerability, and Trump has thrown out a raft of proposals to address it, from $2,000 tariff rebates to 50-year mortgages.

Health care will be a major front in this fight, a traditional Democratic policy strength that the party emphasized during the just-concluded government shutdown.

In isolation, the Democratic demand to extend Obamacare subsidies in perpetuity shouldn’t be sustainable. The party’s position is, in effect, “We passed a sweeping health-care reform that we promised would lower costs, and now that it’s done the opposite, it is incumbent on Republicans, in the name of all that is right and good, to support additional subsidies for the law.”

The GOP is so hopeless on health care that it will have trouble countering this argument. Fifteen years after the passage of Obamacare and after a major attempt to repeal it early in Trump’s first term, it still lacks a concrete alternative of its own, even though the policy direction here should be clear enough.

Obamacare imposed massive new regulations on the individual insurance market in order to cover the sick and lower costs. The fact is that there are better ways to achieve the former goal, and the latter has been completely unrealized.

As Avik Roy of the Foundation for Research on Equal Opportunity points out, Barack Obama ran for president promising that his health care reform would reduce premiums by as much as $2,500 per family. That was as misleading as his promise that “if you like your plan, you can keep your plan.” Roy notes that premiums for the benchmark “silver” Obamacare plans — the law created metallic tiers for various insurance plans — has nearly tripled since 2013.

At the same time, deductibles for those same silver plans have more than doubled, outpacing the rate of increase for employer-sponsored plans.

Democrats no longer pretend that Obamacare is going to reduce costs. Instead, they insist that without expanded credits first passed under President Biden in 2021 and then 2022 — now set to expire — Americans will experience a cost apocalypse. “Cancel the cuts. Lower the cost. Save healthcare,” is how Hakeem Jeffries has put it.

The subsidies, though, only cushion consumers from the worst of a poorly designed system. A basic problem of Obamacare is that it charges young and healthy people higher premiums than they would pay otherwise — making health insurance less attractive to them — to subsidize the premiums of the old and sick.

As Roy observes, it’d make more sense to have so-called reinsurance programs, either at the federal level or in the states, to pay the cost of care for people with preexisting conditions. This alone should reduce premiums for everyone else. The “age band” imposed by Obamacare — mandating that young people can’t pay too much less than old people — should be loosened. Obamacare taxes should be repealed; the law should allow for genuine, bare-bones “catastrophic plans” for those who want one; and states should be given as much leeway to innovate as possible.

Republicans would also be smart to build on a Trump administration rule from the first term that allowed employers to fund accounts — Health Reimbursement Accounts, or HRAs — for employees to buy their own individual coverage.

None of these ideas will make the case for themselves, though. Republicans have to introduce them to the public and explain them, even if they’d prefer to be talking about something else. Failing to do so represents a serious political risk — of either swallowing Obamacare subsidies that they never supported before, or going to the voters next year empty-handed. If they lose the midterms on the issue of affordability, they can’t say that they weren’t warned.

© 2025 by King Features Syndicate