Chief Health Officer John Driscoll is calling the upcoming expiration of the Affordable Care Act’s enhanced subsidies “a tragedy in the making,” warning that millions of Americans are about to be hit with higher premiums, lost coverage and rising medical debt as gridlock in Washington tightens.
Driscoll, who is currently the president of UConn Health after a 25-year career in health care, including a previous position as president of Walgreens Boots Alliance, said reversing the policy amounts to “a self-inflicted wound” that will increase costs for both low-income families and wealthy professionals who thought they were insulated.
Driscoll cited CBO estimates that if Congress allows the subsidies to expire, premiums will rise for about 24 million enrollees in the marketplace and about 2 million people will lose coverage entirely in the short term.
“You don’t solve higher health care costs with fewer people getting insurance,” he said wealtharguing that the system will simply shift the risk and shift the costs onto everyone else. “Whenever you reduce coverage at the bottom, everyone pays more in the middle.”
Increased tax credits, introduced during the pandemic and extended through 2025, helped double enrollment in the marketplace and kept average subsidized premiums below about $900 a year. When it expires, KFF News predicts a roughly 114 percent increase in average premium payments for subsidized enrollees in 2026. Older adults and rural residents would be particularly exposed, with KFF also warning that adults ages 50 to 64 could see average premium increases of 75 percent or more.
The invisible tax to everyone else
Driscoll argued that the real story is a huge cost shift from the government to households and employers, driven by simultaneous Medicaid cuts, work requirements and subsidy cuts. When people lose coverage, he notes, “they don’t stop being covered by the health care system.” Instead, they show up later and sicker, so hospitals and insurers respond by raising prices to anticipate uncompensated care.
When you consider that this is being done to “effectively subsidize a tax break for millionaires and billionaires, that’s going to change health care costs for all of us when people lose coverage,” he added, referring to the One Big Beautiful Bill Act that extended President Donald Trump’s previous tax cuts and introduced new ones.
To Driscoll, the subsidy cliff exposes a deeper “tribal dysfunction” in health policy that has frozen the Affordable Care Act instead of improving it. He called Obamacare “a very good but imperfect solution,” which cut the uninsured rate in half and slowed health care inflation, but said both parties refused to commit to the hard work of updating it. “We’re not putting the patient first,” he said, “we’re putting the policy first,” leaving millions of people faced with the choice of dropping coverage or delaying care for serious conditions.
The political situation
He had a warning for Republicans, calling this mass expiration of health insurance subsidies a “self-inflicted wound” for the party. “They were elected to solve affordability,” he pointed out, and now they will accelerate the problem. But Driscoll said neither side is blameless. “The tragic thing is that neither side really wants to have a sensible conversation about how you really care about more people and care for them sooner.”
It’s true that Democrats ran the ACA, but Driscoll said they’re generally determined to defend something that was itself a compromise, and the other side is playing the offensive. “The danger is that some Democrats don’t want to have a conversation about evolution [the ACA] because they feel they have to defend it, and the Republicans don’t ever want to have a conversation about its evolution because they want to destroy it.” The result is that you end up here, in “some kind of ridiculous no-progress zone.” (Driscoll revealed that he serves as a special health care adviser to Connecticut Gov. Ned Lamont.)
From his point of view now, Driscoll argued that the reason America is plagued by constant health care problems is a mismatch of incentives. “Healthcare is a team sport that continues to be undermined by individual incentives,” he said, noting that costs in the U.S. are twice as expensive as the average industrialized country and not as productive, he pointed out.
In similar countries, about 50%-60% of physicians are primary care, but it is only one in four in the US. The problem is that every doctor wants to be a specialist or a surgeon because that way they will roughly double the salary of a pediatrician or an internist. “Until you change those incentives, people will continue to go to those areas with higher compensation.”
No one has solved this, but there are steps we can take, Driscoll said. He pointed to expanded drug price negotiation, immigration reforms to alleviate shortages of primary care physicians and nurses, “location-neutral” payments so patients are not charged more for identical hospital care, and greater use of bundled and value-based payment models. But we don’t even seem capable of engagement, he argued.
“If the two sides could talk,” Driscoll said, “there’s probably a way they could agree on how to bridge the gap between what Biden and Trump want to do on drug costs. If we could talk, we could probably agree on how to bring back value-based care that would balance the interests of doctors and hospitals and patient outcomes and the government’s obligation.” If only.
This story was originally featured on Fortune.com