The Obamacare Cliff the GOP Wouldn't Own

RachelOkay, so picture this: 2017, some rally, some guy with a microphone promising, quote, "We're going to repeal and replace with something much less expensive and much better."

JordynMuch better.

RachelBeen eight years.

JordynI'm Jordyn, this is Rachel, and you're listening to Red Flag, where we grade the promises against the actual receipts.

RachelAnd the receipt just landed. Premiums up, millions off their plans.

JordynWait, millions?

RachelMillions.

JordynOkay, hold that thought because that number is about to ruin somebody's open enrollment.

RachelThis is not us borrowing a Democrat talking point, just to be clear.

JordynNo, no. This is Republicans, House, Senate, White House, all three, and still no plan sitting on the table when the bill came due?

RachelThat's the part that gets me. A decade of 'we'll fix it' and open enrollment hits and it's just silence.

JordynCrickets.

RachelExpensive Crickets.

JordynExpensive Crickets. I love that. We're using that.

RachelI keep coming back to the receipts question. What did people actually get for that Decade of promises? Spoiler, Not Much, but we're gonna make them show their work today. From the promise to the actual numbers, let's see what happened when those Subsidies expired.

JordynYeah. Let's go find out who owns this.

RachelMm. Ten years, Jordyn. A full Decade of repeal and replace. And when the actual deadline hit at the end of 2025, the enhanced Subsidies just expired. No bill, no backup plan, Nothing.

JordynNot a rumor, not a maybe, it just lapsed.

RachelRight. And they had the House, the Senate, the White House, every lever you could ask for.

JordynAnd still showed up to open enrollment empty-handed.

RachelAnd here's the thing that actually gets me. Open enrollment isn't some surprise event. It happens on the same calendar every single year. Everybody in that building knew this deadline was coming for years.

JordynIt's not like the subsidies expired on a random Tuesday nobody saw coming.

RachelExactly. You don't need a crystal ball to see an expiration date that's already printed in the law.

JordynSo it's not a failure of prediction, it's a failure of follow-through.

RachelRight. A decade of campaign promises is plenty of runway to have something, anything ready to go before that date hit.

JordynAnd instead, it's radio silence right up until the deadline and then just this silence continues.

RachelWhich means every family renewing their plan this year is the one absorbing the gap between the promise and the follow-through.

JordynSo walk me through what that gap actually costs somebody because no plan is an abstraction until you see the bill.

RachelThat's exactly where we're headed next. Okay, numbers. Premiums went up an average of 26% once those enhanced subsidies expired. 26%. That's not a copay bump, that's a car payment. And that's the average. KFF projects annual payments more than doubling for a lot of enrollees. Doubling?

JordynWait, wait, like their whole yearly bill?

RachelYep. Not everyone, but for plenty of families, yeah.

JordynOkay, so picture this. You sign up, the price is the price, everybody's fine.

RachelRight.

JordynAnd then the terms just change quietly, like when you finance a couch at 0% and 18 months later the store calls about the interest that was accruing the whole time.

RachelThat's exactly it.

JordynNobody told you the rate was fake. You just find out at the worst possible moment.

RachelAnd open enrollment is that moment for four million households.

JordynOn paper, it's the same plan. In your bank account, it's a completely different plan.

RachelSo what do people actually do when the bill doubles?

JordynThey can't just eat it.

RachelNo.

JordynSome of them are gonna walk.

RachelSome of them already did.

JordynAnd that's before you even get into what walking actually means. No coverage at all or scrambling for something cheaper with worse benefits.

RachelRight. It's not like there's some magic bargain plan waiting for them. If the subsidized options got this expensive, the unsubsidized ones were never cheap to begin with.

JordynSo walking away isn't relief, it's just trading one hard math problem for a different hard math problem.

RachelExactly. Nobody's escaping the number. They're just choosing which version of it they can live with. So who actually walked out the door?

JordynFamilies USA just crunched the new HHS numbers, and it's ugly. Marketplace enrollment was 23.1 million people in January.

RachelOkay.

JordynBy June, it's 19.2 million.

RachelWait, do that math for me.

JordynAlmost four million people gone. Poof.

RachelFour million. That's like the entire city of Los Angeles deciding they don't need a doctor anymore.

JordynRight. And Families USA isn't shy about why. They're pointing straight at the subsidy expiration.

RachelNow, I'll say the obvious thing. Families USA has a dog in this fight. They're not a neutral referee.

JordynSure, but they didn't invent the enrollment numbers. Those are HHS's own effectuated enrollment. Families USA is just the one reading them out loud.

RachelFair. The messenger has an agenda, the data doesn't care.

JordynAnd that's the split. Is it four million people who found something cheaper somewhere else or four million who just gave up?

RachelBecause those are wildly different outcomes.

JordynThey are. But either way, that's the size of the hole.

RachelA hole nobody in leadership had a Band-Aid for.

JordynAnd here's the part that should actually embarrass them. This wasn't some silent minority grumbling online.

RachelNo?

JordynTheir own voters didn't want any of this to happen.

RachelWait, hold on. Replay that. Not fringe voters, not never Trumpers holding out, their own people?

JordynTheir own people. That's not a talking point. That's the exit interview nobody wanted to read.

RachelSo when we say nearly four million, we're not talking about randoms who never liked the party to begin with.

JordynNo. We're talking about people who signed up in the first place because this was supposed to work for them.

RachelAnd they're the ones who ended up walking or getting priced out or however you want to describe it. However you describe it, it's the same result: coverage lost on this party's watch among its own voters. Okay, so KFF ran a poll in late September right before the cliff hit.

JordynAnd?

RachelFifty-nine percent of Republicans wanted those subsidies extended. Fifty-seven percent of MAGA supporters, same answer.

JordynWait. Wait, their own side?

RachelTheir own side.

JordynThat's not a fringe number. That's a majority.

RachelA majority of the base telling their own party, "Don't let this expire."

JordynSo somebody in leadership had this poll on their desk.

RachelHad to.

JordynAnd did nothing.

RachelKFF didn't bury it either. This wasn't some quiet internal memo. It's a published survey with a methodology and a date attached.

JordynSeptember 23rd through the 29th.

RachelRight before the deadline.

JordynOkay, but here's the thing that got me. CNN had a follow-up in December after the subsidies already lapsed.

RachelWhat'd they find?

JordynSeventy-two percent of Republican ACA enrollees and MAGA supporters combined still wanted the extension even after the sticker shock.

RachelSeventy-two?

JordynAnd CNN's reporting says Republicans in Congress couldn't agree on a floor plan. The White House floated its own extension and pulled it back when their own party balked.

RachelSo it's not that nobody proposed anything.

JordynIt's that whatever got proposed died inside the room.

RachelWith three out of four of their own voters standing outside saying, "Just do it."

JordynThat's the part that should keep somebody up at night in a swing district.

RachelSo if the base wanted this extended, what was the actual Republican plan sitting behind door number two?

JordynOh, you're gonna love this. Timing is everything here.

RachelOkay, so December 2025, timing check.

JordynRight, when people were opening those renewal notices.

RachelABC News reported that Senate Republicans, Cassidy, Crapo, Thune, finally rolled out their own fix.

JordynAnd?

RachelThey scrapped the enhanced tax credits entirely and replaced them with a flat deposit into a health savings account, 1,000 to 1,500 bucks only if you're on a bronze or catastrophic plan.

JordynWait, only the cheap, high-deductible plans qualify?

RachelThat's the catch. If you're on a silver plan because you actually use your insurance, you get nothing.

JordynCool. Cool. Very helpful.

RachelThey pitched it as money going straight to patients instead of insurers.

JordynWhich sounds nice until you realize $1,500 doesn't touch what people were already losing.

RachelNo, it doesn't.

JordynAnd this wasn't even the first swing, was it?

RachelNo. CNN's report on that same poll noted the White House had floated its own expansion plan earlier and then pulled it after other Republicans balked.

JordynSo no unified plan going in?

RachelNone, just competing half ideas that all showed up too late or got yanked.

JordynSo walk me through the order of operations here. Subsidies lapse, people open their renewal letters, coverage drops, and then in December, Senate Republicans go, "Here's our idea"?

RachelYou just, you just wrote a stage direction out loud.

JordynI got excited. Sue me. But seriously, the plan drops after the damage is already visible in the enrollment numbers. That's not a rescue. That's a press release.

RachelIt's a Decade of we'll Fix it, and the actual Fix shows up only once people have already felt the hit in their bank accounts.

JordynThat's the whole indictment right there. Not that they never had an idea. They had an idea. It just arrived after the Sticker Shock, not before it.

RachelIf this had landed in, say, October, before open enrollment even opened, you could call it a plan. Landing in December after people already saw the number on the renewal notice, that's not a plan. That's a reaction.

JordynAnd a Decade of promises should've produced something ready to go before the deadline, not a scramble after it.

RachelSo Trump posts that subsidy money should go directly back to the people instead of to insurers.

JordynWhich sounds great until you realize it's already happening.

RachelRight? KFF's analysis on the HSA replacement plans points out the enhanced tax credits already go straight to the consumer, not the insurance companies.

JordynSo the villain in that post doesn't exist.

RachelThe check's not cut to Aetna. It's cut to you or applied to your premium directly.

JordynOkay, but let's say the HSA fix ships tomorrow, deposit and all.

RachelYeah?

JordynYou still need cash sitting there before you can use it.

RachelThat's the actual problem.

JordynA tax credit lowers your bill at the register. An HSA is a savings account you have to fund first.

RachelSo if you're already choosing between groceries and a premium-

JordynYou don't have spare cash to stuff into a savings account

Rachel... it's a completely different mechanism.

JordynCompletely.

RachelOne meets you where you are. The other assumes you had money to begin with.

JordynAnd that's the part nobody selling this plan wants to sit with.

RachelAnd it's not like the deposit shows up before you need the money either. You're funding the account, then waiting on the reimbursement side of things.

JordynSo even in the best case, you're front-loading cash you may not have for a benefit you get back later. Compare that to a tax credit, which just lowers what you owe right there at checkout, no float required. One's designed for somebody with a cushion. The other's designed for somebody living closer to the edge.

RachelAnd the people getting hit hardest by these premium increases are disproportionately the ones without a cushion to begin with.

JordynWhich is exactly backwards from what you'd want a fix to do.

RachelSo even setting aside the dollar amount not covering the gap, the mechanism itself assumes a financial position a lot of these households don't have. It's not a fix built for the people actually feeling the pain. It's a fix built for a spreadsheet. None of this is happening in a vacuum. No, there was a whole shutdown fight over this exact fight. So rewind to last fall for a second before any of these numbers even existed.

JordynOh, the shutdown. Right, right.

RachelTalking Points Memo called it the longest government shutdown in US history. Forty-three days.

JordynForty-three days of Congress just not funding the government.

RachelAnd the sticking point was exactly this fight. Democrats on the Hill were pushing to extend those subsidies before they expired.

JordynWait, so they saw this coming?

RachelThey saw it coming. That was the whole ask.

JordynAnd Republicans just let the clock run out anyway?

RachelForty-three days. Government closed. People furloughed. And at the end of it?

JordynLet me guess. No deal.

RachelNo deal. The subsidies lapsed right on schedule like none of it happened.

JordynSo what did Forty-three days actually buy anybody?

RachelThat's what gets me. You shut the whole government down over an issue and still walk away with the exact outcome you were trying to prevent?

JordynThat's not a strategy. That's just pain with extra steps.

RachelExtra six weeks of it.

JordynAnd nobody on either side can point to what they got for it.

RachelNot one thing changed about the actual subsidy cliff.

JordynSo the fight happened. The fight failed. The bill still hit.

RachelExactly the same bill, just later.

JordynOkay, so if the shutdown didn't stop it and the poll numbers didn't move anybody, I want to actually see the math, like dollars.

RachelThe HSA money versus what people are actually being charged now?

JordynYeah, side by side, because I don't think it holds up.

RachelI don't either. Let's put the two numbers next to each other and see. Okay, so I want to run this like an actual reconciliation. Does the fix cover the cost line by line?

JordynOoh, Spreadsheet Rachel. I love Spreadsheet Rachel.

RachelSpreadsheet Rachel is tired. So take a household that just got hit with that premium jump we already laid out.

JordynThe one that made people gasp into their coffee?

RachelThat one. Now put the Cassidy-Crapo-Thune deposit next to it. The one we mentioned. Top end of the range.

JordynOne lump sum once a year.

RachelRight, a single deposit into an HSA. Meanwhile, the premium hit is monthly, every single month all year.

JordynSo it's not even the same shape of money.

RachelExactly. One's a drip you feel every paycheck. The other's a check you get once and then you're on your own for eleven more months.

JordynDoes it at least cover the increase for the year?

RachelFor plenty of families, no, not close. The whole design assumes you're on a bronze or catastrophic plan too. So if you're not, you don't even get the deposit.

JordynWait, so some of the people hit hardest by the spike don't qualify for the offset at all?

RachelThat's the math. It's not a replacement for the credit. It's a smaller check aimed at a smaller group.

JordynGreat budgeting.

RachelIt's ABC News reporting the actual terms of that Senate proposal, not us guessing.

JordynAll right, Enough Grading our side's homework for the day.

RachelOne more section left though.

JordynTime to flip it. Where does the other side actually get something right this week?

RachelOkay, Friendly Fire for real this time. Democrats spent that whole shutdown screaming to extend the Subsidies.

JordynAnd the base actually agreed with them. That October KFF poll we ran the numbers on, majority of Republicans were on the Democrat side of that fight.

RachelWait, our listeners are gonna hate hearing that twice.

JordynOnce is enough, but it's still true. The People yelling loudest to extend it were reading the room better than half of the GOP leadership.

RachelThat's not spin. That's just the base wanted the thing their own party's leadership walked away from.

JordynRight. Democrats didn't invent a crisis. They pointed at a real one and said Fix it before January.

RachelAnd Nobody fixed it before January.

JordynNope.

RachelI hate that I agree with this.

JordynDoesn't mean their whole platform's right. It means on this one issue, the loudest voice in the room happened to be correct about what voters wanted.

RachelCredit where it's due. It's not a both sides thing. It's just they called the polling correctly and our side didn't act on it.

JordynExactly. That's the whole segment. Leadership versus base and the gap is the story.

RachelSo where does that gap actually cost somebody a seat?

JordynThat's the next question.

RachelSo open enrollment isn't some abstract policy calendar thing anymore.

JordynNo, it's landing right on top of election season for these households.

RachelGreat timing.

JordynThe renewal notices are hitting mailboxes in conservative districts right as candidates start knocking on doors. You can't design a worse rollout if you tried. Somebody kind of did though.

RachelFair.

JordynI keep thinking about the guy who voted for this party because he wanted lower costs and now he's opening an envelope that says otherwise.

RachelRight before he's asked to vote again.

JordynExactly.

RachelAnd that's the actual question I can't get past. You had the House, the Senate, the White House, an entire decade of promises.

JordynTen years of we'll fix it campaign mailers.

RachelAnd when the moment finally came to hand people a plan, there wasn't one. Not a partial one, not a placeholder, nothing ready when open enrollment opened. Which means the households feeling this hit didn't get burned by bad luck. They got burned by a timeline nobody planned for. So if you controlled every lever of government for a decade, why didn't you have something on the shelf before your own voters felt it? That's the part I keep coming back to. Same. And it's not a hypothetical anymore. It's sitting in people's mailboxes right now. Which is a rough place to be standing a few weeks before election day. That's the receipt, honestly. Let's grade it and wrap this up. Okay, grade time. Decade of promises, zero plan ready when the bill landed. F. Straight up. I'll go easier. A D. Divided government makes big fixes hard.

JordynThere's the gap right there. You're blaming gridlock. I'm blaming leadership that had all three branches and still froze.

RachelFair. But nobody in that building wanted to be the one who cut a check with their name on it.

JordynAnd their own voters paid for that hesitation.

RachelLiterally come January.

JordynCool. Cool, cool.

RachelIf you've got a relative who's gonna bring this up over turkey, send them the episode before they hear it secondhand.

JordynSubscribe wherever you're listening and leave us a rating. It actually helps people find the show. We'll be back next week with more receipts. Grading everybody the same way. See you then.