Should they subsidize "Obamacare" despite their outright hostility to the program? Or should they let health insurance costs skyrocket for millions of Americans? Donald Trump and the Republicans face a difficult dilemma that exposes their divisions and could cost them dearly in the midterm elections this November.
At the heart of the debate is the expiration at the end of December of financial aid that currently allows more than 20 million Americans to afford health insurance through the public program "Obamacare".
For Republican leaders in Congress, it's quite simple: they absolutely must not continue to subsidize this system enacted in 2010 under Barack Obama, which they say is riddled with fraud.
A flagship program of the Democratic president's term, "Obamacare" enabled millions of Americans to obtain health insurance coverage for the first time. But it has been relentlessly challenged since its inception by the American right, which opposes such government intervention in the private health insurance market.
Therefore, it is out of the question for the main Republican leaders to support a three-year extension of these financial aids, as proposed by the Democrats.
But a faction within the party doesn't see it that way.
- Pressure -
In the House of Representatives, more than twenty members of the majority party defied their leader Mike Johnson and supported various initiatives by Democrats to extend subsidies.
On Thursday, four Republican senators refused to follow voting instructions and supported an opposition bill, which nevertheless failed.
That same evening, Donald Trump declared he was ready to work with Democrats to find a solution. This was a rare gesture of openness for the Republican billionaire, who so far has not taken a firm stance.
The pressure is mounting, however: if Congress does not pass any legislation before December 31, health insurance costs will more than double for approximately 22 million middle- and working-class Americans who benefit from this aid program.
A person paying the average annual cost of $888 in 2025 would thus have to pay $1,906 in 2026, according to an estimate by the KFF think tank.
And this comes at a time when Americans already face one of the most expensive healthcare systems in the world, spending on average more than double that of other wealthy countries, according to OECD figures.
– “Finding a compromise” –
The prospect of even higher bills for millions of households from January 2026 is sounding the alarm on the right, less than a year before the midterm legislative elections, when Donald Trump's party will try to preserve its majority in Congress.
On the other side, the opposition is sharpening its weapons. A surge in health insurance costs would be a key argument for the Democrats, who have already decided to focus their campaign against Donald Trump and the Republicans on the cost of living, against a backdrop of persistent inflation.
The Republican Party leadership is now putting forward its own bill, which could be put to a vote next week. But the bill does not include an extension of subsidies and has little chance of passing.
House Democratic leader Hakeem Jeffries said Friday that he was open to dialogue to "find a compromise."
"But Republicans continue to pursue an intransigent approach, which has gotten them nowhere this year," he lamented.
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