WASHINGTON – During a recent telephone town hall, Maryland Representative Andy Harris, who leads the conservative Freedom Caucus in the House, was immediately challenged with a pressing question about the Affordable Care Act. A caller, concerned about her cousin’s disabled son potentially losing his insurance coverage under the law, sought clarity on the Republicans’ strategy for healthcare.

The caller, identified as Lisa from Harford County, Maryland, expressed her worries. “Now she’s facing premiums that are two or three times higher than what she currently pays,” Lisa stated. “Could you explain what the Republican plan is for health insurance?” she inquired.

Despite being a seasoned Republican serving his seventh term, Harris struggled to provide a definitive response. “We believe the solution is to work on reducing premiums for everyone,” he mentioned, adding that Congress would likely “negotiate some kind of solution” in the future.

This lack of clarity highlights an ongoing challenge for the Republican Party: fifteen years after the Affordable Care Act’s implementation, members remain critical of the law but divided on alternatives. This internal conflict has surfaced prominently during the government shutdown, with Democrats leveraging the issue of increasing premiums to urge Republicans to extend the expiring subsidies of the law, colloquially known as Obamacare.

Former President Donald Trump and GOP leaders have indicated a willingness to contemplate extending the enhanced tax credits set to expire at the end of the year, but they insist that Democrats must first vote to reopen the government. Meanwhile, individuals enrolled in these insurance plans are already receiving notifications about significant premium hikes expected in 2026.

As town hall meetings draw crowds of concerned voters, the absence of a clear Republican healthcare plan is becoming a potent political issue, particularly as the midterm elections loom on the horizon.

“Premiums are going up whether it gets extended or not,” said GOP Sen. Rick Scott. “Premiums are going up because health care costs are going up. Because Obamacare is a disaster.”

‘Concepts of a plan’

At the center of the shutdown — now in its fourth week with no end in sight — is a Democratic demand that Affordable Care Act subsidies passed in 2021 be extended.

Trump has long promised an alternative. “The cost of Obamacare is out of control, plus, it’s not good Healthcare,” he wrote on Truth Social in November 2023. “I’m seriously looking at alternatives.”

Pressed on health care during a September 2024 presidential debate, Trump said he had “concepts of a plan.”

But nearly 10 months into his presidency, that plan has yet to come. Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, told NBC on Wednesday, “I fully believe the president has a plan,” but didn’t go into details.

Republicans say they want a broader overhaul of the health care system, though such a plan would be difficult to advance before next year. Party leaders have not outlined how they’ll handle the expiring tax credits, insisting they won’t negotiate on the issue until Democrats agree to end the shutdown.

A September analysis from the nonpartisan Congressional Budget Office estimated that permanently extending the tax credits would increase the deficit by $350 billion from 2026 to 2035. The number of people with health insurance would rise by 3.8 million in 2035 if the credits are kept, CBO projected.

Asked Wednesday on CNN whether Republicans have a plan to address the subsidies if the government reopened, House Speaker Mike Johnson said they had “proposals” that can be “ready immediately.”

“It’s a very complicated, very complex issue, that requires a long time to build consensus around,” he said.

A growing political issue

With notices of premium spikes landing in mailboxes now and the open enrollment period for Affordable Care Act health plans beginning Nov. 1, the political pressure has been evident in Republican town halls.

In Idaho, Rep. Russ Fulcher told concerned callers that “government provided health care is the wrong path” and that “private health care is the right path.” In Texas, freshman Rep. Brandon Gill responded to a caller facing a sharp premium increase by saying Republicans are focused on cutting waste, fraud and abuse.

Harris echoed a message shared by many in his party during his Maryland town hall, saying costs are “just going back to what it was like before COVID.”

But the number of people who rely on Affordable Care Act health insurance has increased markedly since before the pandemic. More than 24 million people were enrolled in the marketplace plans in 2025, up from about 11 million in 2020, according to an analysis from the health care research nonprofit KFF.

Sara from Middleville, Michigan, told Rep. John Moolenaar during his town hall that if health insurance premiums go up by as much as 75%, most people will probably go without heath care. “So how do you address that?” she asked.

Moolenaar, who represents a district he handily won last year, responded: “We have time to negotiate, figure out a plan going forward and I think that’s something that could occur.”

Some Republicans have shown urgent concern. In a letter sent to Johnson, a group of 13 battleground House Republicans wrote that the party must “immediately turn our focus to the growing crisis of health care affordability” once the shutdown ends.

“While we did not create this crisis, we now have both the responsibility and the opportunity to address it,” the lawmakers wrote.

Some Republicans dismiss projections that ACA premiums will more than double without the subsidies, calling them exaggerated and arguing the law has fueled fraud and abuse that must be curbed.

Many Democrats credited their ability to flip the House in 2018 during Trump’s first term to the GOP’s attempt at repealing Obamacare, and they’re forecasting a similar outcome this time.

About 4 in 10 U.S. adults say they trust the Democrats to do a better job handling health care, compared with about one-quarter who trust the Republicans more, a recent AP-NORC poll found. About one-quarter trust neither party, and about 1 in 10 trust both equally, according to the poll.

A looming internal GOP fight

Even as GOP leaders pledge to discuss ending the subsidies when the government opens, it’s clear that many Republican lawmakers are adamantly opposed to an extension.

“At least among Republicans, there’s a growing sense that just maintaining the status quo is very destructive,” said Brian Blase, the president of Paragon Health Institute and a former health policy adviser to Trump during his first term.

Michael Cannon, director of health policy studies at the libertarian Cato Institute, said he’s working with multiple congressional offices on alternatives that would let the subsidies end. For example, he wants to expand the Affordable Care Act exemption given to U.S. territories to all 50 states and reintroduce a first-term Trump policy that gave Americans access to short-term health insurance plans outside the Affordable Care Act marketplace.

Cannon declined to name the lawmakers he’s working with, but said he hopes they act on his ideas “sooner than later.”

David McIntosh, president of the influential conservative group Club For Growth, told reporters Thursday that the group has “urged the Republicans not to extend those COVID-era subsidies.”

“We have a big spending problem,” McIntosh said.

“I think most people are going to say, OK, I had a great deal during COVID,” he said. “But now it’s back to business as usual, and I should be paying for health care.”

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Swenson reported from New York.