OPINION:
The debate in Washington over health care has exposed some hard truths about America’s health insurance system as presently constructed under Obamacare. The program depends on taxpayer dollars to stay afloat, and there is little transparency as to where those dollars end up.
Democratic politicians have allowed the misunderstanding to take hold that Obamacare subsidies provide a needed lifeline for working families. Here’s the truth: These subsidies do not go to financially struggling households. Taxpayers are funneling tens of billions of dollars to health insurance companies already awash in profits. Even with this financial fire hose continually flowing, these insurers continue to raise premiums and make their customers jump through hoops to get essential health care.
I was in Congress when the poorly named Affordable Care Act was conceived by Democrats and passed without a single Republican vote. Since President Obama signed his namesake legislation into law in 2010, the country’s largest health insurance companies have collectively pulled in more than $371 billion in profits — not revenue, but profits — while families pay an average $26,000 a year just to have health coverage that may or may not be there when they need it. (UnitedHealthcare, the largest of the health insurance behemoths, denies 1 of every 3 claims it receives.)
Extending the Obamacare subsidies would give the health insurance industry another $350 billion in taxpayer dollars over the next decade.
So what is the connection between the Democrats and the health insurance oligarchs? It is a tale as old as time. Roughly 2 of every 3 dollars in political contributions from health insurance companies go toward Democratic candidates, but it goes deeper than that. Few organizations work harder to elect Democrats to office than AARP. The organization collected a whopping $9 billion check last year from UnitedHealthcare for allowing its name to be used in the branding of United’s Medicare Advantage and supplemental insurance policies.
This occurred as UnitedHealthcare generated more than $4 billion in profits during the third quarter of 2025 alone.
You know that swamp Americans want drained? This should be “Exhibit A” of said swamp.
What is increasingly clear is that the Affordable Care Act is not working. From its inauspicious beginning with a nonfunctioning website, it has been a dysfunctional program in which millions of Americans wouldn’t be able to afford coverage if taxpayers did not step in to pay a multibillion-dollar tab year after year. Our national approach to health care should not make insurers rich and working households financially depleted and anxiety-ridden. We should not have to endure crisis after crisis every time federal subsidies are about to expire.
It’s time to fix what’s broken, and the solution is simpler than anyone in Washington is letting on. The sweetheart deal between Democrats and the health insurance industry is hurting the country and must be ended in favor of fixing the system and ensuring it works as originally intended. That starts with reining in pharmacy benefit managers, the insurer-owned middlemen inside vertically integrated insurance giants that restrict access and inflate costs. Getting this done has broad bipartisan support, and it would show that Congress is willing to take on the industry rather than shield it.
In Medicare alone, nonpartisan watchdog organizations have already identified nearly $1 trillion in waste, fraud and abuse. Let’s make the mega insurers end their profit schemes and get the system working for the American people again. Republicans have an opportunity to advance an alternative that makes optimal use of market principles instead of Obamacare’s perverse hybrid of crony capitalism and irresponsible governance.
Instead of deciding yay or nay on these continuing Obamacare subsidies, we should be talking about how to deliver higher value for the patient. In all this debate, no one is talking about how to deliver higher value for the patient, which should be the primary objective. A system in which money follows the family rather than an insurance company could be a welcome outline.
If Republicans hand Democrats and the insurers another win on Obamacare, they shouldn’t be surprised when the same pressure tactics return. Insurers, not taxpayers, should be covering the costs of the shutdown that benefited them. With more agreement than ever that the current system isn’t delivering, the focus should shift to building one that is affordable and sustainable for the long term.
When this happens, America wins.
• Michael C. Burgess, M.D., represented Texas’ 26th Congressional District from 2003 to 2025. Before that, he practiced as a doctor of obstetrics and gynecology for more than two decades.
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