Rising premiums? Don’t blame the ACA

When health insurance premiums rise, critics reflexively blame the Affordable Care Act. It’s a convenient narrative — but a false one.

Yes, ACA plans cost more on paper. That’s because the law ended insurance practices that kept premiums low by denying coverage to people with preexisting conditions, stripping out essential benefits, and cutting people off when they got sick. Cheap insurance was often useless insurance.

For more than 90% of ACA enrollees, the number that matters isn’t the sticker price — it’s what they actually pay. Income-based tax credits cap monthly premiums and have kept coverage affordable for millions.

What’s driving increases now isn’t the ACA itself, but broader health care inflation, rising hospital and labor costs, and expensive new drugs. The biggest threat to affordability, however, is political: enhanced premium tax credits are set to expire at the end of 2025. If Congress lets them lapse, many families will see their premiums jump sharply — some could see them more than double.

At some point, it’s fair to ask whether a system that requires constant subsidy fixes to remain affordable should give way to a simpler, single-payer approach (universal health care).

That outcome wouldn’t be a failure of the Affordable Care Act. It would be a failure of lawmakers.

The ACA raised standards, expanded coverage, and protected consumers. Whether it remains affordable is a choice Congress still controls.

Linda Schreiber

Iowa City