As millions face a steep rise in insurance costs, lawmakers continue a long battle over who should pay for health care [View all]

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As millions of Americans face a steep rise in health insurance costs, lawmakers continue a century-long battle over who should pay for health care
Published: December 19, 2025 8:17am EST

Robert Applebaum
Senior Research Scholar in Gerontology, Miami University


(The Conversation) Dec. 15, 2025 – the deadline for enrolling in a marketplace plan through the Affordable Care Act for 2026 – came and went without an agreement on the federal subsidies that kept ACA plans more affordable for many Americans. Despite a last-ditch attempt in the House to extend ACA subsidies, with Congress adjourning for the year on Dec. 19, it’s looking almost certain that Americans relying on ACA subsidies will face a steep increase in health care costs in 2026.

As a gerontologist who studies the U.S. health care system, I’m aware that disagreements about health care in America have a long history. The main bone of contention is whether providing health care is the responsibility of the government, or of individuals or their employers.

The ACA, passed in 2010 as the country’s first major piece of health legislation since the passage of Medicare and Medicaid in 1965, represents one more chapter in that long-standing debate. That debate explains why the health law has fueled so much political divisiveness – including a standoff that spurred a record-breaking 43-day-long government shutdown, which began on Oct. 1, 2025.

In my view, regardless of how Congress resolves, or doesn’t resolve, the current dispute over ACA subsidies, a durable U.S. health care policy will remain out of reach until lawmakers address the core question of who should shoulder the cost of health care. ..........................(more)

https://theconversation.com/as-millions-of-americans-face-a-steep-rise-in-health-insurance-costs-lawmakers-continue-a-century-long-battle-over-who-should-pay-for-health-care-271901