Emily Greene Brey: Pennsylvanians want affordable health care, not more Obamacare

Last month, four Republicans in the U.S. House of Representatives broke away from their party to support Democrats’ number one spending demand, namely, a three-year extension of Joe Biden’s Covid-era enhanced Obamacare subsidies.

Three of the four breakaways are from Pennsylvania: Rob Bresnahan, Brian Fitzpatrick, and Ryan Mackenzie. They may think their aisle-crossing will pay dividends for them at election time, but they’re wrong. While supporting Obamacare may win over some swing voters, it will greatly depress enthusiasm among grassroots GOP voters. Republicans currently have a slim, one-seat majority in the U.S. House.

The enhanced subsidies, which were enacted in 2021 on a temporary basis, expired on January 1st. Democrats are now pushing to reinstate them retroactively, and to extend them for an additional three years. With a House vote on the Democrats’ plan expected as soon as next week, the breakaway Republicans have a chance to rectify their mistake before it’s too late.

Prior to the holidays, Americans for Prosperity asked 1,000 registered voters to identify their top concerns as we head into 2026. Far and away, voters’ top concern is the high cost of living (69 percent). Their second highest concern is the high cost of health care (44 percent). An overwhelming 82 percent say bringing down health care costs should be a top priority in Congress. And 65 percent say they expect political candidates to have a clear plan to reduce costs.

Clearly, affordability is top of mind for voters. But Obamacare subsidies do nothing to reduce health care costs. In fact, they promote higher insurance premiums by weakening insurers’ incentive to compete on price. And by making insurance “free” for millions of people, they weaken consumers’ incentive to shop for value.

The extra subsidies also very expensive, costing taxpayers $30 billion a year. And according to the Government Accountability Office, they fuel massive fraud. A recent GAO investigation uncovered hundreds of thousands of fake Social Security numbers being used in Obamacare to access subsidies for nonexistent people, as well as underhanded practices by unscrupulous insurance company representatives. Fake “enrollees” and garden-variety enrollment fraud are now costing taxpayers an estimated $27 billion a year. 

A vote to reinstate the Biden-era subsidies is a vote to increase waste, fraud, abuse, and medical inflation — a slap in the face to Pennsylvania’s patients, taxpayers, and struggling middle-class families.

Instead of an Obamacare bailout, Congress should enact free-market health reforms that would actually reduce medical costs.

Republican leaders have proposed a number of good reforms. Perhaps the most promising is to expand access to tax-free Health Savings Accounts (HSAs). An HSA is a tax-advantaged, personally owned “medical wallet” that can be used to pay for a wide range of medical costs, including doctor’s appointments, surgeries, and prescription drugs.

HSAs reduces costs because when people are spending their own money, they shop for value. Eighty-three percent of Americans believe HSAs reduce health care costs, and they’re right. A five-year Health Care Service Corporation study found HSA account holders spent 25 percent less on hospital stays and 14 percent less on specialist care.

Fidelity estimates that a couple who retire at age 65 will need a staggering $345,000 in savings to cover the many health care expenses that Medicare does not. Merrill Lynch estimates that a 40-year-old couple in average health who contribute the maximum amount each year to their HSAs, and take advantage of “employer matching” at work, will have more than $600,000 set aside to cover their health costs by age 67. That’s a real solution.

Right now, every penny of Obamacare subsidies goes directly to insurance companies. Instead, let’s send that money directly to patients. Deposit it in people’s tax-free HSAs. Doing this would deliver better health care at lower cost.

In AFP’s polling, 80 percent of voters prefer direct financial assistance to consumers rather than insurers. And 82 percent support making HSAs available to all Americans. (Right now, only about 20 percent of consumers are eligible to establish these accounts.)

Sadly, Representatives Bresnahan, Fitzpatrick, and Mackenzie are on record supporting a wasteful extension of a temporary Biden-era policy that increases health care costs. But it’s not too late for them to correct that error. They can switch to supporting better policies that actually reduce health care costs for struggling Pennsylvania families.

Emily Greene Brey is state director for Americans for Prosperity-Pennsylvania, a nonpartisan grassroots organization that believes freedom and opportunity are the keys to unleashing prosperity for all.