Authored by Lawrence Wilson via The Epoch Times,
Obamacare had problems even before it launched in 2014. Marketplace websites were glitchy during the open enrollment period, frustrating many would-be customers.
Sweeping changes ushered in by the Affordable Care Act, the law creating Obamacare, all but guaranteed that premiums would increase—which they did by 23 percent in the program’s first year.
Even so, public opinion swung in favor of Obamacare starting in 2017 and remains positive, according to KFF Health Tracking polls.
More than 24 million people were insured through the program by 2025.
And insurers learned to thrive under the new rules, more than doubling annual revenue to $1.1 trillion and consistently generating a profit between 2014 and 2024.
Problems do persist, however.
Premiums have more than doubled over 12 years. Some consumers have only a few plans to choose from. And flaws in the program’s design continue to waste taxpayer dollars.
Lawmakers on both sides of the aisle have proposed solutions, many with bipartisan support. Yet permanent reform remains elusive.
The reason may have less to do with the ideas themselves and more to do with the most persistent disagreement between Republicans and Democrats: the role of the federal government.
Here are three commonly proposed remedies for problems within Obamacare, and why those problems remain.
1. Increase Plan Options
Of the more than 1,100 health insurers doing business in the United States, about 10, on average, offer plans through Obamacare in each state.
About 5 percent of Obamacare users have only one or two insurers to choose from.
“Obamacare created a system that left American families with fewer choices,” said Sen. Rick Scott (R-Fla.), who proposed legislation to improve Obamacare in 2025.
Scott’s proposal would have allowed consumers to buy health insurance across state lines, which is now prohibited by most states with limited exceptions.
Five years ago, Sens. Tim Kaine (D-Va.) and Michael Bennet (D-Colo.) proposed allowing more choice by allowing consumers to opt into Medicare in counties where fewer than three insurers offered Obamacare plans. That plan, called Medicare X, later expanded to other counties with high-cost plans and few options.
Bennet and Kaine said the plan would both reduce costs and offer health coverage to people with few options. The plan was introduced in 2021 and again last year.
Others have suggested broadening the availability of catastrophic plans, which have low premiums but high deductibles.
That proposal and Scott’s proposal had been suggested by Democrats in 2017.
Still others have proposed allowing insurers to offer short-term health insurance plans through Obamacare. These three-month to six-month plans are popular with people between jobs or in a waiting period for employer-sponsored insurance.
“Short-term plans typically offer far lower premiums, substantially broader provider networks, and greater overall value for many middle-class families,” Brian Blase, president of Paragon Health Institute, said.
None of these ideas received a vote in Congress.
Conservatives were skeptical of the Medicare X proposal, seeing it as a step toward socialized medicine.
“Democrats claim that they just want to offer another health insurance choice. But Medicare X would simply nudge us along toward the Democrats’ endgame: a complete government takeover of the health insurance system,” Sally C. Pipes, president and CEO of Pacific Research Institute, wrote on the think tank’s website in 2024.
Left-leaning politicians and analysts have been skeptical of any plan that would offer what they see as inferior health coverage through Obamacare, including short-term insurance and catastrophic plans.
“Short-term coverage is not community-rated (that is, people can be charged more based on their health status, gender, or other factors) and it typically does not cover preexisting conditions,” Mark A. Hall and Michael J. McCue wrote in a 2022 article for The Commonwealth Fund.
2. Empower Consumers
Obamacare subsidizes health insurance for people earning between 100 percent and 400 percent of the federal poverty level. The subsidy comes in the form of an advanced tax credit. But the money is paid directly to insurance companies, not to the insured individuals.
President Donald Trump and several others have proposed making those funds available to consumers, which they say would increase choice and lower prices.
Trump’s plan, and some others, would provide funded Health Savings Accounts, which enrollees could use only for health expenses. That would include buying insurance, paying out-of-pocket expenses, or buying health care directly from providers.
Scott made a similar proposal, as did Sens. Mike Crapo (R-Idaho) and Bill Cassidy (R-La.), and Sen. Roger Marshall (R-Kan.).
“Giving billions of taxpayer dollars to insurers is not working to reduce health insurance premiums for patients,” Crapo said in a statement announcing his plan in December 2025. “We need to give Americans more control over their own health care decisions.”
The Crapo–Cassidy plan failed to advance in the Senate last year. None of the other plans have even been put to a vote. Democrats have opposed the idea as a halfway measure that would undermine the value of Obamacare.
Health Savings Accounts are available only with insurance plans that have a high deductible, leading some analysts to conclude that they wouldn’t benefit people who have the most trouble affording health care.
“While healthier people could benefit … sicker people could be stuck with higher premiums or higher out-of-pocket health costs,” wrote Larry Levitt and Cynthia Cox of KFF.
Democrats objected also to other provisions of the Crapo–Cassidy plan, like verifying citizenship and immigration status before enrolling in coverage, and excluding abortion as an essential health benefit in Obamacare plans.
Senate Minority Leader Chuck Schumer (D-N.Y.) called the plan “junk insurance.”
3. Fix Structural Problems
One feature of Obamacare was intended to lower premium prices but produced the opposite result.
Insurers must offer cost-sharing reductions to customers making less than 250 percent of the federal poverty level who choose a silver-level plan.
The cost-sharing reductions mean lower copays and deductibles, which helps low-income enrollees.
It also increases costs for insurers, so the federal government reimbursed them for the added expense.
But a federal judge ruled that those reimbursements were improper because Congress had never authorized funds for them through an appropriations bill. Cost-sharing reduction payments to insurers were discontinued in 2017. However, insurers are still required to offer the cost-sharing reductions.
To compensate, insurers raised premiums on the silver-level plans, a practice known as silver loading.
Because all premium subsidies are based on the cost of a silver-level plan, any increase to silver-plan premiums has the knock-on effect of increasing federal subsidies on every plan sold through Obamacare.
The overall effect added billions per year in costs to taxpayers.
Politicians from both major parties have called for Congress to fix the problem by appropriating money to pay for the cost-sharing reductions. That would save taxpayers nearly $37 billion and reduce premiums for the most common Obamacare plans by 11 percent, according to the Congressional Budget Office.
Then-Sen. Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.) proposed this and other program changes in 2017.
The bipartisan House Problem Solvers Caucus also pitched the idea that year.
Rep. Mariannette Miller-Meeks (R-Iowa) introduced a health care bill in 2025 that included funding for cost-sharing reductions.
The idea is included in Trump’s Great Healthcare Plan, released in January.
Despite having bipartisan support, this proposal appears to have been overshadowed by larger questions about Obamacare.
The 2017 Murray–Alexander plan was proposed at a time when many Republicans were intent on repealing and replacing Obamacare.
Trump opposed the proposal, according to then-White House press secretary Sarah Huckabee Sanders, because it did not go far enough to expand options and drive competition.
“This president certainly supports Republicans and Democrats coming to work together, but it’s not a full approach, and we need something to go a little bit further to get on board,” Sanders told reporters in 2017.
Democrats opposed the Miller–Meeks proposal because it did not extend the expiring enhanced tax credits for Obamacare, which was their primary legislative aim in late 2025.
Rep. Bobby Scott (D-Va.) urged colleagues to vote against the Miller-Meeks proposal, saying, “This plan does nothing to extend the [Obamacare] enhanced tax credits which are set to expire.
Jeremy Nighohossian of the Competitive Enterprise Institute suggested that some policy makers oppose funding the cost-sharing reductions precisely because the higher federal subsidies that result from silver loading serve a political end.
“Some may prefer the indirect subsidy increase because it raises the proportion of the population with insurance,” Nighohossian wrote in January on the think tank’s website.
The Impasse
The legislative impasse over improving Obamacare appears to arise from the basic difference in approach by Republicans and Democrats to health care financing.
Republicans generally favor deregulation and other marketplace reforms that they believe will increase competition and lower prices.
“As President Trump has said, he will make our health care system better by increasing transparency, promoting choice and competition, and expanding access to new affordable health care and insurance options,” White House press secretary Karoline Leavitt told The Poynter Institute in 2024.
Republican proposals for Obamacare generally follow that blueprint: add choices, improve competition, and allow the market to lower prices.
Democrats generally favor increased government intervention in the form of regulation and subsidization with the goal of ensuring access to health care services for everyone.
“Access to high-quality health care should be a right available to every single American,” House Democratic Leader Hakeem Jeffries (D-N.Y.) said in December 2025. “One of the ways we can make sure that we strive to achieve that principle is to extend the Affordable Care Act tax credits.”
Democrat-led bills to extend those credits failed to advance in both the House and Senate. Republican proposals to increase choice and competition also failed to advance.
Obamacare’s benchmark silver plan premiums for 2026 increased by about 26 percent.
