Obamacare’s broken promise: Affordability

OPINION:

When the Affordable Care Act was passed in 2010, the American people were promised one thing above all else: affordability. It was a goal so central it was written into the name of the legislation. Yet, over 15 years later, we find ourselves in a system that is far from affordable.

What we have today is a subsidy-fueled illusion with spiraling costs hidden by taxpayer dollars and deficit spending. Premiums continue rising, and the subsidies keep increasing. Since Obamacare passed, premiums in the individual market have more than doubled, far outpacing both medical inflation, at 51%, and overall inflation, at 49%.

The politically convenient path is to maintain the status quo and dodge the unpopular necessity of reforms. But this ignores the harsh reality that our health care programs are ballooning beyond our means. By making promises we cannot afford, we aren’t just delaying the problem; we are sabotaging our country’s future. I refuse to stand by while these programs risk failing the very people they were created to protect.

Last summer, I joined my Republican colleagues to pass the landmark Working Families Tax Cuts Act. This legislation delivered historic relief to American families while reining in the unsustainable Obamacare provisions and strengthening core programs like Medicaid.

Obamacare was sold as a solution for health care affordability and accessibility, but its incentive structure has created a system reliant on unsustainable federal spending. Medicaid was originally established in 1965 as a lifeline for vulnerable populations: low-income families and children, individuals with disabilities, seniors whose expenses aren’t fully covered by Medicare, and pregnant women.

However, the 2010 expansion extended Medicaid coverage to include able-bodied adults earning up to 138% of the Federal Poverty Level, a shift forcing the program to move away from its core mission. To incentivize this change, the law provided states with a higher federal match rate for the expansion population than for the vulnerable groups the program was originally designed to serve. This upside-down incentive structure prioritizes expansion at the expense of those who need the program most.

It is false to say that Republicans “cut” Medicaid through the Working Families Tax Cuts. In fact, Medicaid funding will still grow significantly over the next decade. The non-partisan Congressional Budget Office projects that Medicaid spending will add up to $8.6 trillion over the next ten years. Because Medicaid’s federal matching rates favored expansion enrollees under Obamacare, many states underinvested in their traditional Medicaid populations. The real question is one of prioritization. When states added able-bodied adults to Medicaid, they left individuals with disabilities stuck on waiting lists. Republican reforms adjust funding formulas and policies to direct attention back to core populations.

The Congressional Budget Office warned early on that these Medicaid expansions and subsidy phase-outs would discourage work, leading some to reduce their hours or leave the labor force entirely just to retain their benefits.

To address this perverse incentive, we have established a national Medicaid work requirement for able-bodied adults aged 19 to 64. Participants will be required to work or engage in community service for 80 hours a month, with mandatory exemptions for those with medical issues, caregiving responsibilities, or other hardships. This reform does not rip away coverage, as some claim; instead, it restores the dignity of work as a path to independence while continuing to support those truly in need.

Obamacare promised lower costs and broader access, but delivered a system where affordability is an illusion propped up by trillions in debt. To achieve sustainable reform, we must look toward solutions that prioritize patients. This includes establishing a parallel marketplace for lower-premium insurance, empowering individuals by redirecting spending into Health Savings Accounts (HSAs), and enacting rigorous measures to eliminate waste, fraud, and abuse. I urge readers to explore the provisions within House Republican’s “Making the American Dream Affordable Again” plan as we work to build health care systems that deliver.

As a physician, I took an oath to “do no harm.” As your representative, I apply that same principle to a health care system that is clearly hurting. Americans deserve a government that doesn’t just manage the status quo, but also protects and stabilizes our future.

• Rep. Mike Kennedy, M.D., has represented Utah’s 3rd Congressional District since January 2025. He co-chairs the Biomedical Research Caucus and serves on the GOP Doctors’ Caucus.