I am an Affordable Care Act (ACA) recipient, long time advocate of Medicare for all, and worked as a Cancer Information Specialist prior to the ACA. My background gives me a larger view, beyond my own personal experience, of the issues facing so many Americans who struggle to pay for medical treatment.
I took the train down to our nation’s capitol to meet with three Republican Congressmen from Pennsylvania: Brian Fitzpatrick PA-01, Ryan MacKenzie PA-07, and Dan Mueser PA-09, to express my concerns about increasing health care costs in 2026, especially if Congress lets the ACA enhanced subsidies expire at the end of this year.
None of the Congressmen, including mine – Brian Fitzpatrick – were available for a meeting, so I met with their staff. While I was relieved to hear the Congressmen all share my concerns about rising healthcare costs, I was disappointed by the solutions they are gravitating towards.
All three Congressmen support implementing Health Savings Accounts (HSA) in order to give the power of the purse to individuals instead of directly to insurance companies. The Congressmen assume this will control insurance premium costs, through forced competition. However, there are countless providers who already work through the state ACA exchanges, and people are free to choose any provider to use their subsidy. HSAs would do nothing to help regulate insurance companies or reign in premiums. Plus, the amount the Congressmen are talking about funding each HSA is $1,000, which a drop in the giant bucket that constitutes healthcare costs in America. HSAs are not enough, and are not available to enough people.
Another solution that everyone supports is eliminating $0 premiums, because the Congressmen assume that most of those accounts are actually ghost accounts that are set up by brokers who identify people that qualify for 100% ACA subsidies, then sign them up without their knowledge and hand the insurance company the subsidy without the person ever using the insurance. I think we can all agree that a practice like that needs to stop immediately. But raising premiums for people who can’t afford health insurance and therefore qualify for a 100% subsidy is the wrong approach. Congress should stop these brokers without punishing the people who are already being taken advantage of.
A third solution involves adding income caps back to subsidy requirements. I think we can all agree that millionaires shouldn’t be getting subsidies, but I urge Congress to keep the cap high enough to protect small business owners who might make above $250K, but still need help paying for healthcare for their families.
My suggestion to Brian Fitzpatrick is that Congress should extend the ACA premium tax credits “as is” for at least one year, while diligently looking into solutions such as regulating insurance companies and brokers, and carefully consider income caps to keep the ACA functioning for millions of Americans who rely on it.
The solution is to fix the ACA, not dismantle it.
