Health insurance premiums jumped an average of 14 percent last week, following a 20 percent hike just one year ago. This surge in costs comes as the Trump administration carries out what is described as the most sweeping rollback of social spending in American history. Millions of Americans are being thrown off Medicaid, and enhanced subsidies for individual health insurance on Affordable Care Act (ACA) exchanges are not being extended.
Bernie Sanders responded to the news, stating, “We have a fundamental choice to make. We can maintain a broken healthcare system that allows insurance companies to make billions by raising premiums by 14%-35% next year. Or we can enact Medicare for All and save the American people $650 billion a year.” Sanders argues that replacing all private health insurance with a government-run, single-payer system is the only alternative to soaring premiums. The Atlantic suggests a simpler alternative: restoring the subsidies enacted under the Biden administration.
Capital's Gains, Workers' Losses
Before the ACA passed 16 years ago, nearly 20 percent of Americans under 65 lacked insurance. By 2023, that figure had been cut in half. However, the current administration's actions are reversing these gains. Nearly 3 million Americans lost their health-care coverage just last year. The Congressional Budget Office projects that by 2028, the number of uninsured Americans will have risen by a third, with almost 10 million losing coverage.
Hundreds of rural hospitals are now at risk of closing, further eroding access for working-class communities. Republicans have not acknowledged the direct effect of their subsidy cuts. Donald Trump rarely mentioned health care during his most recent presidential campaign, and his 2024 convention speech, running over an hour and a half, omitted any reference to plans for cutting the ACA.
Mehmet Oz, administrator for the Centers for Medicare and Medicaid Services, claimed last month that the administration is cutting benefits for “millions of people, literally, who are getting insurance that they don’t want; they don’t even know they have it.” He asserted that the cuts were meant to strengthen the ACA by eliminating fraudulent claims. Oz cited the conservative Paragon Health Institute, which claimed 6 million “improper” recipients this year, including 1.5 million ineligible for subsidies. This claim is based on the questionable premise that not filing a claim means a person doesn't want or exist for coverage.
Most ineligible recipients, the article notes, are not pretending to be poor. They are inflating their income to qualify for coverage due to a perverse, Republican-imposed policy. The ACA split coverage into two programs: Medicaid for the poorest households (below 138 percent of the poverty line) and subsidized exchange coverage for those above it. A Supreme Court ruling 14 years ago allowed states to opt out of Medicaid expansion, creating a coverage gap in nine states. Desperate for care, many in these Republican-led states have resorted to inflating their income, making their payments potentially illegal but their need for coverage very real.
The State as Enforcer
Republicans have consistently opposed the ACA, with nearly the entire Republican caucus voting to repeal the law 9 years ago. In 2025, the GOP allowed health subsidies to expire and voted to claw back Medicaid. This demonstrates the state's role in protecting accumulated wealth by systematically undercutting programs that provide collective resources, thereby pushing individuals back into the private market where surplus extraction is maximized.
The American health-care system was built around private, employer-provided coverage, making a transition to a fully public system difficult. Even those who dislike the current system often resist new taxes or policy changes that would disrupt their existing coverage. Barack Obama himself stated that he would design a single-payer system if starting from scratch, but settled for a hybrid model to avoid disrupting care for the majority of working adults.
Managing the Contradictions
Democrats, while advocating for universal health care, have pursued incremental expansions, such as Medicare and Medicaid under Lyndon B. Johnson and the Children’s Health Insurance Program under Bill Clinton. Under Barack Obama, Democrats established a universal health-care program relying on market regulation, subsidies, and Medicaid expansion. Undocumented immigrants, a fifth of the uninsured, remained ineligible. This effort faced ferocious right-wing backlash.
When Democrats regained control of government 5 years ago, they expanded subsidies, reducing the uninsured rate from 9.7 percent to 7.7 percent within two years. Republicans have since allowed these higher subsidies to expire, causing the uninsured rate to rise again. Congressional Democrats recently shut down the federal government in an effort to defend health-insurance subsidies, highlighting their commitment to managing the system's contradictions rather than fundamentally altering its structure.
Progressive activists, particularly those associated with the Democratic Socialists of America (DSA), are criticized for blaming the wrong party for the crisis. The DSA's platform includes universal health care, public ownership of major corporations, ending immigration enforcement, and “abolishing the carceral forces of the capitalist state.” While the Democratic Party also supports universal health care, their approach has historically been one of market-based solutions and subsidies, which are temporary and reversible gains within the existing system. The core distinction lies not just in the goal, but in the structural means to achieve it.