ALLENTOWN, Pa. (AP) — Republicans in key U.S. House battlegrounds are working to contain the political fallout that may arise when thousands of their constituents face higher bills for health insurance brought about by the Affordable Care Act.
For a critical portion of the Republican majority, the impending expiration of so-called enhanced tax credits after Dec. 31 is a pressing concern as they face potential headwinds in the 2026 midterm elections, which will be key to President Donald Trump’s agenda.
One of those is first-term U.S. Rep. Ryan Mackenzie, a Republican, whose victory for the Allentown-area seat last year was among the narrowest in the nation.
Mackenzie is part of a bipartisan group that has pushed for an eleventh-hour compromise, advocating for an expansion of tax credits that seeks to fix perceived flaws and lower health care costs. But the push is a long shot because of strong GOP opposition to the health care overhaul known as “Obamacare.”
“I think we have to face the reality of where we’re at right now, and even if you have a broken system, that doesn’t mean you shouldn’t offer or give help to people who are facing these high costs right now,” Mackenzie said in an interview with The Associated Press.
Democrats have laid the groundwork, starting with this fall’s shutdown fight, to make health care a central focus of next year’s campaigns.
The party’s strategy to capture the House majority focuses on pinning higher food, health insurance and utility bills on Trump and Republican policies.
Republicans torn over an extension
In Washington, Republicans in competitive House districts have written or signed bills that would temporarily extend tax credits. A new bipartisan proposal unveiled Thursday has so far drawn the support of about 15 Republicans and 20 Democrats.
“I have 40,000 people in my district who rely on this health care and doing nothing to prevent an increase in their premiums is wrong,” said U.S. Rep. Jen Kiggans, R-Va., a sponsor of the plan.
Thirteen Republicans — including Mackenzie — signed a letter in late October to House Speaker Rep. Mike Johnson, R-La., encouraging the temporary extension of the tax credits, saying that letting them “decline without a clear path forward would risk real harm to those we represent.”
Johnson did not commit to a short-term extension vote before Jan. 1 and dismissed the looming premium increases as affecting a small percentage of Americans.
More than 24 million people have ACA health insurance, including farmers, business owners, and other self-employed workers who have no other health insurance options through their jobs.
Many receive subsidies that reduce their out-of-pocket costs. Those subsidies include enhanced tax credits, which were added and then expanded under Democratic President Joe Biden when his party held the majority in Congress.
Some Republicans — including Mackenzie — are backing their support for an extension with the caveat that changes need to be made. One is to eliminate insurance broker fraud. Another is rejecting subsidies for higher earners.
Time is running out
U.S. Rep. Kevin Kiley, one of the California Republicans whose districts were redrawn to favor a Democrat, sponsored a bill to extend the tax credits for two years. The bill would also impose an eligibility cap to exclude people with higher incomes.
Kiley said the current system isn’t working, but there isn’t enough time to make systematic reforms before millions of Americans “suddenly pay double their premiums.”
U.S. Rep. Jeff Van Drew, R.N.J., also has a bill to temporarily extend the appropriation and said leaving the subsidy would make it harder to keep a majority next year.
“People say, ‘Well, there aren’t that many people,'” Van Drew said. “The kind of multi-district midterm elections we’re going to have are going to be decided by one or two points. It’s going to be close. It’s going to be close and it matters. It absolutely matters politically.”
U.S. Rep. Richard Hudson of North Carolina, chairman of the House Republican campaign arm, said the tax credits won’t be “decisive” in next year’s election, when voters may have other things on their minds.
Democrats will run on affordability
But U.S. Rep. Suzan DelBene of Washington state, who heads the House Democrats’ campaign arm, said swing district Republicans won’t be able to distance themselves from the expiration of the tax credits.
“The number one issue across the country is affordability, and health care is a key part of that,” DelBene said.
The Congressional Budget Office estimates that 3.8 million more people will be uninsured in 2035 if the tax credits are not expanded. But the tax credits also come at a cost: Extending them would increase the deficit by $350 billion over the next decade.
The expiration of the tax credits means enrollees will see annual premiums more than double — from an average of $888 in 2025 to $1,904 in 2026, according to KFF, the nonprofit health research organization. This is an increase of 114%.
The size of the increases vary by state, age and income, and will be more extreme in the Mackenzie district, according to state data, which puts the average premium increase at 178 percent.
A Democratic primary field is preparing for the nomination to challenge Mackenzie. They say they’ve heard of people struggling to afford rising premiums.
One of those Democrats, Ryan Crosswell, said the increase in insurance costs is a “broken promise” by Trump, Republicans and Mackenzie. Another Democrat, Carol Obando-Derstine, called the impending expiration a “crisis created by (Mackenzie).”
Mackenzie says he has made it clear repeatedly that he supports an extension, but that “I’m not the speaker, I don’t set the calendar or the agenda. I’m not the leader, I can’t call bills.”
Entrants facing tough choices
In the Mackenzie district, more than 20,000 people received increased tax credits in 2025, according to state data. He won his race last year by 1 percentage point, or about 4,000 votes.
One of those 20,000 people in Mackenzie District is Patrick Visconti, who switched to a low-premium, high-deductible plan because he couldn’t afford to keep his plan with a premium doubling from under $200 to over $500 a month.
Visconti, 59, who works as a freelance landscaper and bus driver, said the plan he chose was “bad coverage.”
“I’d rather pay the $200 a month. But I can’t get anything for $200,” Visconti said.
Lynn Weidner, a Mackenzie District home care worker who works nearly 80 hours a week, said her $400 premium will increase to $680. But, she said, she’s leaning toward selecting the plan because she has various conditions — including an iron deficiency — that require regular medical care.
“So I’m trying to find places where I can cut money so I can afford insurance in January, which is stressful,” Weidner said.
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Freking reported from Washington. Follow Marc Levy on X at: https://x.com/timelywriter