Stop Propping Up Obamacare

Originally published on Substack. 

Washington has a predictable reflex: when a temporary policy fails, keep it alive long enough to become permanent.

That’s exactly what’s happening as several Republican lawmakers push to extend the COVID-era enhanced ACA subsidies—subsidies that were never intended to survive this long.

As Isabelle Morales makes brutally clear in her ATR commentary, “Spineless Obamacare ‘Compromise’ Plans Must Be Rejected”, the political class is again mistaking subsidy expansion for reform. And this time, it’s not just Democrats driving the mistake. A few Republicans are now carrying the water.

The lawmakers Isabelle names are not fringe players:

• Rep. Jen Kiggans partnering with Rep. Josh Gottheimer
• Sen. Bernie Moreno and Sen. Susan Collins with a two-year extension
• Sen. Roger Marshall proposing a five-year continuation

Different packaging—same policy failure. Every proposal expands Obamacare, increases dependency, and entrenches federal control. Not one addresses the structural causes of high costs. Not one empowers patients. Not one bends the cost curve in the right direction. They extend the dysfunction while pretending to fix it.

Healthcare Was Broken Long Before the ACA—But Washington Keeps Making It Worse

Isabelle is right to highlight the latest capitulations. But the deeper truth matters even more:

Obamacare didn’t break American healthcare.

Government broke it long before—and both parties helped.

The original distortion is the employer-sponsored insurance tax exclusion, which encourages employers—not workers—to choose health plans because the benefit is tax-free for businesses but taxable for individuals. This single policy ensures:

• workers don’t control their health dollars
• insurance is tied to employment, not individuals
• prices stay hidden
• insurers face weak competition
• patients behave like passengers, not consumers

Then came decades of mandates, regulations, and price controls. By 2010, healthcare was already a top-down maze. The ACA didn’t unwind any of that. It cemented it.

And COVID-era subsidies didn’t solve affordability problems; they masked them. Now that they’re expiring—exactly as Democrats designed—Washington is scrambling to keep the illusion going.

Isabelle’s numbers make the danger obvious:

• Nearly $450 billion in additional debt for a 10-year extension
• Subsidies reaching households earning $200,000–$300,000
• Incentives for insurers to raise premiums, confirmed by CBO analyses
• Shockingly widespread fraud, including 58,000 subsidies paid to the dead, documented in federal oversight investigations

This is not compassionate policymaking. It’s policy avoidance.

Free-Market Provide the Real Fix

While some lawmakers are bending to political pressure, the free-market movement has already outlined the alternative.
Brian Blase at the Paragon Health Institute has shown conclusively that ACA subsidies inflate premiums and reduce insurer accountability.

Paul Winfree at EPIC has documented how federal entitlements crowd out innovation and entrench bureaucracy.
And Dr. Deane Waldman and I have developed the clearest structural reform available today:

👉 Empower Patients: A Plan to Fix Healthcare

Our premise is simple:

Healthcare works only when patients—not employers, insurers, or Washington—control the dollars.

Empower Patients would:

• transfer the employer tax benefit directly to workers
• place those funds in no-limit Health Savings Accounts
• allow families—not HR departments—to choose their coverage
• restore real price transparency
• force providers and insurers to compete
• reduce administrative bloat organically
• and target assistance without expanding federal control

Nothing in the subsidy-extension proposals does any of this. They merely preserve the incentives that broke the system.

​The Real Problem Isn’t Obamacare—It’s Policymakers Who Keep Rescuing It

Isabelle calls these proposals “spineless,” and she’s right. But the deeper point is this:

Every extension—no matter who introduces it—makes healthcare more expensive, less transparent, and more dependent on Washington.

Some lawmakers are trying to look pragmatic. Others fear being blamed for premium hikes. Others simply want to avoid the tough structural choices.

But governance built on fear is not reform. It’s how bad systems survive. Healthcare will not get better by subsidizing its failures. It will only get better when policymakers choose reforms that trust patients instead of bureaucracies.

Closing: Congress Doesn’t Need More Patches. It Needs Courage.

This isn’t a Democrat problem or a Republican problem. It’s a Washington problem.

The free-market movement—Isabelle, Blase, Winfree, Waldman, and others—has already mapped the way forward. The only question now is whether lawmakers will keep propping up failure or finally choose the harder path of real reform.

Patients don’t need more subsidies for a broken system. They need a system where they control their dollars and their healthcare.

👉 If you want more sharp, principled commentary like this, share and subscribe and check out my work to Empower Patients.