ALLENTOWN, Pa. (AP) — Republicans in key U.S. House districts are working to contain the potential political fallout from thousands of voters facing rising health insurance costs through the Affordable Care Act.
For a small segment of the Republican majority, the imminent expiration of the so-called enhanced premium tax credit after Dec. 31 is a pressing concern as they could face headwinds in the 2026 midterm elections that are critical to President Donald Trump’s agenda.
One of them is first-term U.S. Rep. Ryan Mackenzie, D-Pa., whose win last year in the Allentown-area seat was one of the narrowest in the country.
McKenzie is part of a bipartisan group that has been pushing for a last-minute compromise, advocating for an extension of the tax credit to try to fix known flaws and lower health care costs. But that push has little hope because of deep-seated Republican opposition to the health care overhaul known as “Obamacare.”
“I think we need to face the reality of where we are right now, and even if you have a problem with your system, that doesn’t mean you shouldn’t provide or provide relief to individuals who are dealing with high costs,” McKenzie told The Associated Press in an interview.
Starting with this fall’s government shutdown fight, Democrats have been laying the groundwork to make health care a focus of next year’s campaign.
The party’s strategy to win the House majority was to pin higher bills for groceries, health insurance and utilities on Trump and Republican policies.
Republicans divided on extension
In Washington, Republicans from hotly contested House districts have drafted or signed bills to temporarily extend the tax credit. A new bipartisan proposal unveiled Thursday has so far the support of about 15 Republicans and 20 Democrats.
“With 40,000 people in my district relying on this health care, it’s wrong to do nothing to prevent premiums from skyrocketing,” said Rep. Jen Kiggans, R-Va., the plan’s sponsor.
Thirteen Republicans, including McKenzie, signed a letter to House Speaker Mike Johnson of Louisiana in late October encouraging a temporary extension of the tax credits, saying letting them “lapse without a clear path forward could cause real harm to the people we represent.”
Johnson has yet to commit to a vote on a short-term extension before Jan. 1, arguing that the coming premium increases affect a small number of Americans.
More than 24 million people have ACA health insurance, including farmers, business owners and other self-employed people who work and have no other health insurance options.
Many people benefit from subsidies that lower out-of-pocket costs. Those subsidies include enhanced premium tax credits that were added under Democratic President Joe Biden and then expanded when Democrats held the majority in Congress.
Some Republicans, including McKenzie, have expressed support for an extension but warned changes must be made. The first is to eradicate fraud by insurance brokers. Another is to eliminate subsidies for high-income earners.
time is running out
U.S. Rep. Kevin Kiley, a California Republican whose district has been redrawn in favor of Democrats, introduced a bill to extend the tax credit for two years. His bill would also impose income eligibility caps to exclude high earners.
Kelly said the current system isn’t working, but there isn’t enough time to make systemic changes before millions of Americans are “suddenly paying double their premiums.”
U.S. Rep. Jeff Van Drew, D-Calif., also introduced a bill to temporarily extend the credit and said letting the subsidies lapse would make it harder for Republicans to retain the majority next year.
“People say, ‘Well, there aren’t many people,'” Van Drew said. “What kind of election we’re going to have in the midterms across multiple districts will be determined by one or two points. It’s going to be close. It’s going to be tight, but it does matter. It absolutely matters politically.”
U.S. Rep. Richard Hudson of North Carolina, chairman of the House Republican campaign arm, said the tax credit won’t play a “decisive role” in next year’s election because voters may have other things on their minds.
Democrats will run on affordability
But Washington state Rep. Susan DelBene, chair of the House Democratic campaign arm, said Republicans in swing districts can’t distance themselves from the expiration of the tax credit.
“The number one issue across the country is affordability, and health care is a critical part of that,” DelBene said.
The Congressional Budget Office projects that 3.8 million people will be uninsured by 2035 if the tax credit is not extended. But the tax credits come at a cost: extending them would increase the deficit by $350 billion over the next decade.
The expiration of the tax credit means enrollees’ annual premiums will more than double, from an average of $888 in 2025 to $1,904 in 2026, according to KFF, a health care research nonprofit. The increase was 114%.
Premium increases vary by state, age and income, with increases in the McKenzie region being more extreme, with an average premium increase of 178%, according to state data.
The main Democratic camp is preparing to challenge McKenzie’s nomination. They said they’ve heard from people who are struggling to afford rising premiums.
One of the Democrats, Ryan Crosswell, said the insurance premium increases were a “broken promise” by Trump, Republicans and McKenzie. Another Democrat, Carol Obando-Derstine, called the expiring term “a crisis of (McKenzie’s) own making.”
McKenzie said he has repeatedly made clear his support for an extension, but “I’m not the speaker, I don’t set the calendar or the agenda. I’m not the leader, I can’t introduce bills.”
Enrollees face tough choices
More than 20,000 people in the McKenzie region will receive enhanced tax credits by 2025, according to state data. He won last year’s race by 1 percentage point, or about 4,000 votes.
Patrick Visconti, one of those 20,000 residents in the McKenzie area, switched to a low-premium, high-deductible plan because he couldn’t afford to keep his plan with premiums more than doubling from less than $200 to more than $500 a month.
Visconti, 59, a self-employed landscaper and bus driver, said the insurance plan he chose was “crappy insurance.”
“I’d rather pay $200 a month. But I can’t get anything for $200,” Visconti said.
Lynn Weidner, a home caregiver in the McKenzie District who works nearly 80 hours a week, said her premiums increased from $400 to $680. But, she said, she was inclined to choose the plan because she has multiple conditions, including iron deficiency, that require regular medical care.
“So I’m trying to find places where I can save money so I can afford insurance come January, which is stressful,” Weidner said.
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Frekin reported from Washington. Follow Marc Levy on X: https://x.com/timelywriter