How much will your doctor bill cost since Congress won’t pay to keep rates low? | Opinion
Editor’s note: Welcome to Double Take, a conversation from opinion writer David Mastio and editor Yvette Walker, tackling news with differing perspectives and respectful debate.
Yvette Walker: This week on Monday was the 16th anniversary the Affordable Care Act was signed into law, known (for good or bad) as Obamacare. Since the Republican-controlled Congress denied extending subsidies to help keep insurance premiums lower, however, Kansas and Missourians, along with others across the country, are getting off its rolls.
Judging from pre-ACA times, experts and policymakers think they’ll simply drop health care insurance — first, the young and healthy, and later, the older and sick who can’t afford the premiums or are denied care. That’s worrying, especially for a graying population.
I was, if not shocked, but saddened, to hear the tales of an Overland Park woman who told KCUR her premiums went up $1,000 a month.
The ACA led to millions of Americans gaining health coverage without lifetime limits, and put protections in place for people with preexisting conditions. People had access to health benefits, including preventive and rehabilitative care, prescription drugs, wellness visits and contraceptives, and mental health and substance use treatment, among many others.
One of its most immediate and significant impacts was the increase in health coverage, bringing millions of previously uninsured Americans into the health care system. Coverage eliminated lifetime and annual limits on essential health benefits, providing financial security to individuals facing serious and long-term medical conditions.
Got a preextising condition? No problem. High blood pressure and diabetes? You’re still insurable.
David Mastio: Whether your insurance does any good is a different question.
Yvette: Hey, the ACA was far from perfect. But we’re already seeing the results of the end of subsidies: About 1 in 10 people (9%) who were enrolled in an ACA marketplace health plan last year are now uninsured following the lapse of enhanced subsidies that reduced their monthly premiums, according to a new survey by KFF, a nonpartisan health policy research group.
Poll findings also reported more people said they downgraded health insurance or face financial stress due to higher costs for health care.
What’s our next option? Trump Rx?
David: Trump has promised a health plan since his first term and never delivered, so I doubt there will be much help from him. His prescription drug discounts are like handing out temporary coupons and saying you’ve solved inflation.
Back to your comments Yvette, you pack a lot of faith into the Biden administration’s “subsidies designed to lessen the burden of insurance payments.” They were an emergency measure passed to combat COVID-19 and were always supposed to sunset.
Like a lot of things about Obamacare, they were passed on a lie, one that the press covered for at the time. Democrats never intended the subsidies to end because they are necessary to hide the fact that Obamacare has not stopped rising insurance costs. Democrats passed them and figured they could obfuscate the sunset clause with a lot of bellyaching.
In any case, if Obama or anyone else designed the Affordable Care Act to be affordable, it was not. We know how government subsidies work: They fuel inflation by hiding costs from consumers. You can see what government subsidies have done to the cost of higher education and child care, to name two.
We know how to keep costs down, and that is by letting consumers feel the prices for the goods and services they want. That reality check disciplines the charges of health care providers in ways nothing else can. Just look at the fact that LASIK eye surgery (generally not covered by insurance) is actually declining after inflation, while medical inflation for insurance-covered services is out of control.
Do you have any ideas for controlling medical inflation other than more subsidies?
Yvette: Like I said, it wasn’t perfect, but it did more to give people health care options than we had seen in years. Now, we’re in a health care crisis. Boomers are aging and will need more care. Those below the poverty level are losing Medicaid benefits under the One Big Beautiful Bill. And now, the ACA is becoming, as you said, less affordable.
People like you and I have been fortunate enough to have health care benefits under our employers for most of our lives, but that’s not everyone. Shouldn’t our government protect the health of its electorate? Shouldn’t a healthy population fall under life, liberty and the pursuit of happiness?
We do need to get a sincere handle on insurance premiums and cost gouging, and that will take time and must come from the top, meaning our government. But for today, no, I don’t have any ideas other than more subsidies. Neither did the first, and apparently, the second Trump administration. It’s time to fork over the cash to keep our people healthy.
David: That is just pouring good money after bad. We’ve done the experiment of intense government regulation of supply and subsidies for demand for more than a half century. It doesn’t work.
I’ll give you an example. Missouri has a “certificate of need” program where health care providers have to go to state government and ask permission before they can open a new surgery center or radiology center to compete with existing providers. Sometimes the state says no or needlessly delays competition.
Yvette: You’re talking about red tape. I’m talking about healing our people. I agree, they don’t work in concert. But until Congress renews subsidies that doesn’t matter.
David: Restricting supply while you subsidize demand is the basic economics recipe for inflation. It results in the affordability crisis we have today. There are dozens of other ways state, local and federal government restrict the supply of medical care all in the name of planning, much of it left over from laws passed in the 1960s and 1970s that were dumb when they were implemented. But it is even more obvious today.
We have to stop this insanity and design a market that puts pressure on prices while allowing investors to build new and creative ways to serve the health care market. This is not complicated stuff. We can unleash the same forces that gave us artificial intelligence and the smartphone to better and cheaper care of our health. Freedom and responsibility are very helpful in running the world if you only let them work their magic.
This story was originally published March 26, 2026 at 5:08 AM.
