This story blames Republicans for high ACA health insurance premiums – even though the ACA was designed, written and implemented by Democrats. The ACA failed to lower health insurance premiums and Congress, in 2021, acknowledged health insurance then cost more than the ACA’s own definition of “unaffordable”.
Going through HealthCare.gov, before 2021, I found and documented scenarios where the annual premiums equaled a family’s entire annual income.
In 2021, Congress bailed out the ACA by offering subsidies to about 80% of plan buyers.
Here we are in 2025, and per the media, the high ACA premiums are the fault of Republicans: Thousands of Oregonians face sharp health insurance premium hikes in 2026 as enhanced ACA subsidies expire – oregonlive.com
The ACA was poorly designed and could never accomplish the goals used to sell it to “The stupid American voter” (Jonathan Gruber, Ph.D., ACA policy architect).
To illustrate, pre-ACA, 35 states ran their own individual market “high risk” pool programs. Post-ACA, all of those very expensive patients were merged into the small state-level individual market ACA risk pools. These were very expensive patients to insure.
Similarly, about 25% of the uninsured had pre-existing conditions and some portion of these ended up in the small ACA individual market pools. The effect was the individual market turned into a quasi-high risk, high-cost insurance pool. From 2014-2017, there were mechanisms in the ACA to help balance the risks among all insured – but those risk sharing provisions expired, and premiums shot up in price.
How high? For us, in 2024, two adults cost about $2,000 per month (if unsubsidized) for a low end “Bronze” plan, with a $19,200 annual family deductible. There were a few areas in the country that cost 50-100% more than this for what used to be called “catastrophic insurance” policies. When deductibles are this high, it’s not your corporate-type insurance plan – it’s a very expensive, catastrophic coverage only plan.
Another problem was the ACA’s subsidy program was not based on insurance premium costs! Instead, it was based on the local poverty rate and multipliers of the poverty income level – which had nothing to do with insurance premiums and their prices. The ACA was totally broken.
This occurred because of Gruber’s failed policy architecture for the ACA, that was passed by and implemented by the Democrats. Hence, blaming the Republicans in 2025 is stupid journalism.
The root cause was that the ACA could not work as originally designed due to it turning the individual market into a high risk, high-cost insurance program.
