The Affordable Care Act, commonly called Obamacare, was signed into law in 2010 and rolled out in 2014. Its goal was simple: expand health coverage, protect people with preexisting conditions, and bring down the overall cost of care. For a short time it seemed to work. But more than a decade later, the law has become a symbol of rising premiums, distorted markets, and dependence on federal subsidies.
Experts, lawmakers, and even some Democrats now admit that Obamacare has failed to control costs. Instead, it helped create a system where prices rise faster than inflation, competition shrinks, and consumers are trapped in expensive insurance plans that often hide their true costs. Critics argue that these outcomes were inevitable in a system built on government control rather than real market competition.
Rising Costs and a Market Gone Wrong
When Obamacare was created, the Congressional Budget Office predicted that 29 million people would enroll by 2019. The real number was closer to 11 million. At the same time, premiums exploded. Even before the so-called enhanced tax credits took effect, premiums had already more than doubled since 2013. By 2025 they had increased nearly 133 percent, which was about four times the overall rate of inflation.
While supporters blamed aging populations, rising wages, and costly medications, many analysts argued that Obamacare itself was the main driver of the premium spike. The one-size-fits-all rules, mandatory benefits, and guaranteed coverage regardless of preexisting conditions removed incentives for insurers to compete on price or quality. Younger and healthier people left the system, leaving an older and sicker pool that drove costs even higher.
This spiral was masked by massive federal subsidies. By 2024, 80 percent of Obamacare customers paid no more than ten dollars per month for their premiums. Meanwhile, taxpayers footed an estimated 138 billion dollars per year in subsidies. When patients pay almost nothing, insurers feel almost no pressure to control prices, and they raise premiums year after year knowing taxpayers will absorb the increase.
Fraud, Overuse, and a System with No Discipline
Once Congress expanded the subsidies in 2021, enrollment doubled. But so did abuse. Eligibility checks were relaxed, brokers received commissions for signing people up, and millions were enrolled without their knowledge. Nearly 4 million people who were enrolled in zero-premium plans in 2024 made no medical claims at all, costing taxpayers around 35 billion dollars for people who may not have even known they had coverage.
At the same time, employers found incentives to drop coverage altogether. Before Obamacare, 85 percent of companies with 25 to 49 employees offered insurance. By 2025 that number had fallen to 64 percent. Some employers realized it was cheaper to push workers toward subsidized plans instead of offering their own.
Why Costs Were Doomed to Rise
Critics say none of this should be surprising. Obamacare’s design separated the consumer from the true cost of care. Doctors and hospitals face little competition because patients rarely shop for price or quality. Insurers do not have to persuade customers with better deals because subsidies guarantee revenue. And the American Medical Association, which restricts the supply of new doctors, keeps the system artificially tight and expensive. Fewer doctors means higher prices, longer waits, and no downward pressure on costs.
In short, Obamacare removed the market forces that reward efficiency and punish waste. Instead of innovation and competition, the system grew more centralized, more bureaucratic, and more expensive.
The Looming Crisis and Deadlines in Congress
The most urgent problem now is the expiration of enhanced subsidies on December 31. Without an extension, millions of Americans will face premium hikes so large that many are expected to drop coverage entirely. The Congressional Budget Office estimates that 4 million more people will become uninsured in the next few years if the subsidies disappear.
Open enrollment for 2026 begins November 1 in most states, which means Congress is nearly out of time. Lawmakers must decide whether to extend the subsidies, redesign the system, or replace it altogether.
Republicans say extending the subsidies simply throws more money at a broken model. Democrats argue that without subsidies, many families will be priced out overnight.
Choices Congress Faces
Congress has only a few options:
- Extend the enhanced subsidies for another year or longer. Democrats support this, even though they acknowledge it does nothing to control underlying costs.
- Let the subsidies expire, which Republicans say is necessary to stop rewarding insurers for raising premiums.
- Pass structural reform, which could include high-risk pools for those with expensive conditions, expanded Health Savings Accounts, or direct cash assistance to Americans instead of subsidies to insurance companies.
- Begin a full overhaul, something experts say is overdue but politically difficult.
Senate hearings this month showed deep divisions. Some lawmakers, including Sen. Ron Johnson, argue that only a return to a competitive market will lower prices. Others want more government oversight, higher corporate taxes, and tighter rules on insurers.
What People Are Saying
Experts from across the spectrum agree on one point: the system is broken.
Sen. Bill Cassidy said Obamacare “failed to control health care costs.”
Sen. Peter Welch admitted, “We did fail to bring down the cost of health care.”
Former Trump adviser Brian Blase said the ACA “entrenched an inefficient insurance-dominated health sector.”
President Trump argued that the only workable plan is “sending the money directly back to the people” instead of funneling billions to large insurance companies.
Meanwhile, people on the ground are already feeling the consequences. A 31-year-old entrepreneur in Maine says she will drop coverage entirely next year when her premium jumps. A 64-year-old in West Virginia expects to pay 2,800 dollars per month and is saving every dollar she can just to afford her medication.
Families, retirees, and young workers all face a future where health costs keep rising and choices keep shrinking.
Possible Solutions Moving Forward
Republicans and some health economists support market-based reforms such as:
- high-risk pools for expensive conditions
- expanded Health Savings Accounts
- direct primary care
- health sharing ministries
- cash payments allowing consumers to buy insurance directly
These ideas aim to reintroduce competition, give patients control of spending, and force doctors and hospitals to compete on price and quality.
Democrats propose:
- higher taxes on corporations
- stricter rules for insurers
- more government negotiation of drug prices
But these proposals do not address the fundamental problem of a system where consumers no longer see prices and providers no longer face real competition.
The Bottom Line
Obamacare was built on good intentions, but its socialist structure created predictable results. A system where government controls prices, where subsidies hide true costs, where patients are insulated from spending, and where the supply of doctors is tightly restricted cannot remain affordable.
Without price competition or transparent quality measures, costs rise endlessly. That is exactly what has happened. And unless Congress acts decisively, those costs will consume an even larger share of American incomes while coverage becomes more limited each year.
Whether lawmakers extend subsidies or pursue major reform, the deadlines are approaching fast. The decisions made in the coming weeks will determine whether the country continues down the current path or finally begins the difficult work of rebuilding a competitive, patient-centered health care system.
I would contend that Obamacare was not really “about” any of the claims made then, or now. I would contend that the point of Obamacare was the consolidation of Insurance & Medical care for the purpose of managing the planned COVID DIVERSITY GENOCIDE. Without the consolidation, government would have been hard pressed to force hospitalization and the banning of friends, family and loved ones from being with, and looking out for those killed by those hospitals. Without the consolidation it would have been much harder to force small Doctors and employers to ban people, fire people or allow them to kill people with the $480,000 in bribes offered to the medical industrial complex for using remdisivir, midazolam and ventilators to kill people and then claim they died of COVID. Without all of that consolidation it would have been much more difficult to shove the lies down the population’s throat and there would have been much more resistance to the deadly, maiming shots…which were the point of the entire COVID Haox.