Rising costs and cuts to coverage under GOP leadership

Sue Dinsdale

Politicians in Washington, D.C., are getting ready to shut down the federal government once again, despite single-party Republican control of the House, Senate and the Presidency. 

This time, health care costs and access is the sticking point, preventing lawmakers from getting to an agreement that would keep critical services going without interruption. 

Earlier this year, the Republicans passed and President Trump signed a massive bill, the One Big Beautiful Bill Act (OBBBA), that extended trillions of dollars in tax breaks that would otherwise have expired this year. The lion’s share of those tax breaks will go to wealthy households making over $400,000 a year and to large corporations through extra loopholes that were reinstated in the law. 

But in this vast tax giveaway, the GOP omitted one critical tax benefit that over 20 million Americans need to lower their health costs: premium tax credits for Affordable Care Act marketplace coverage. 

Nearly half of Americans get health insurance coverage through Medicaid, Medicare or buy private insurance through a state or federal ACA marketplace. In Iowa, nearly 137,000 people are enrolled in the marketplace. The vast majority of enrollees, over 90%, qualify for tax credits to help cover the cost of their premiums so they can afford the coverage. 

Thanks to Medicaid expansion and to enhanced premium tax credits, the number of uninsured people has hit a record low over the last several years by making coverage affordable even as the price of health insurance has continued to creep upward. 

But now, President Trump and the GOP majority are refusing to extend the enhanced premium tax credits which expire at the end of this year. Without a renewal or extension, 4.6 million people will lose their coverage.

But that’s not all. Millions more will be forced to pay hundreds and, in some cases, thousands more for their health insurance without an extension of the premium tax credits. For example, health care costs will quadruple for individuals making just $39,142 a year as well as families of four with combined incomes of around $80,000 a year. 

Health insurance corporations are responding to potential loss of customers caused by the Republican’s refusal to renew premium tax credits-as well as a host of other changes President Trump’s Administration has made to limit access to health coverage by raising their premiums. Health insurers have already announced an 18% hike in premiums in 2026 — that’s the largest increase since 2017. 

The sharp hikes in premium costs will affect not just people with ACA coverage but also people who get coverage at work. Employers are bracing for their highest spike in 15 years according to the National Survey of Employer-Sponsored Health Plans, which surveyed 1,700 companies about health costs. Those higher costs will filter down to employees and to customers as businesses struggle to stay competitive while maintaining benefits that help them retain employees. 

Democrats refuse to support any government funding bill that does not include an extension of the tax credits for 20 million people and that doesn’t reverse the cuts to Medicaid which would leave another 10 million people without insurance and close hundreds of hospitals and nursing homes over the next decade. 

Republicans on the other hand, including every single Iowa representative and senator, continue to refuse to take action to protect healthcare for millions — forcing a government shutdown that will only make things worse for Americans who depend on basic services like Medicare, Social Security, education, public safety and many others funded at least partially by the federal government. 

Not only are Republicans not doing anything to make insurance more affordable, they also are doing nothing to stop the health insurance companies or the drug manufacturers from hiking their prices astronomically. In fact, their OBBBA rewards these companies for price gouging and profiteering by lavishing them with tax breaks and loopholes that allow them to keep more of their profits. Meanwhile, average working Americans pay a greater share of their income for health care as the price of everything else — groceries, housing, transportation — is going up. 

Republicans will try to shift blame for the shutdown, but the reality is that they hold a majority in both chambers of Congress and the Presidency so they are ultimately the decision-makers on whether the cost of healthcare goes up and down as well as on whether the government stays open. As more and more Americans are forced to pay thousands more or to drop their coverage, they will know who to blame. 

Sue Dinsdale is the Executive Director of Iowa Citizen Action Network and the State Lead for Health Care for America NOW.