The Brian Lehrer Show Republicans and Health Care
Dec 2, 2025
Jonathan Cohn, a health policy journalist and author, delves into the current state of ACA subsidies and Republican divisions over the issue. He highlights who relies on these subsidies and explains the 2021 enhancements that improved access. Cohn also discusses Trump's mixed proposals to extend support and the challenges of routing funds directly to individuals. As he explores Democratic negotiations and enduring health care cost issues, listeners gain insight into the complex landscape of American health care reform.
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Subsidies Drove Enrollment Surge
- The ACA marketplaces expanded coverage by requiring comprehensive plans and offering income-based tax-credit subsidies.
- The 2021 temporary enhancement doubled enrollment but will expire and raise costs for over 20 million people if not extended.
Trump's Numeric Proposal Was A Starting Point
- The White House produced a numeric two-year extension proposal with modifications aimed at winning Republican support.
- The proposal offered a starting point for bipartisan talks but never reached a formal rollout.
GOP Is Deeply Divided On Extension
- Republicans split into factions: some want to extend subsidies to protect constituents, others oppose any aid tied to Obamacare.
- A coalition of Democrats plus enough pragmatic Republicans could pass an extension if leadership allows floor votes.
