When the Democrats made a deal with the Republicans to re-open the government last November, after the longest government shutdown in US history, they co-signed the end of affordable health insurance for millions of Americans. Despite their promises to continue negotiating with Republicans to maintain the Affordable Care Act’s healthcare subsidies, the deadline passed without a deal, and a subsequent House vote to extend them has been languishing for months in the Senate. Meanwhile, the cost of ACA premiums has skyrocketed by 114% on average.
With the price of everyday goods from gasoline to groceries ballooning thanks to Trump’s war on Iran, working people are being forced to choose between health insurance and household needs. Relief is nowhere on the horizon as Trump eyes more imperialist adventures, which he will fund by slashing more healthcare and vital social services.
Healthcare in the United States is already the most expensive in the world, with 40% more spent on healthcare per person and worse outcomes than any other wealthy country. We need an all-out fight for universal healthcare and other social services that ordinary people desperately need, and we cannot rely on the Democrats or the courts to win that for us—only organized working-class struggle can.
How ACA Subsidies Made Healthcare More Affordable
The Affordable Care Act’s Premium Tax Credit (PTC) has existed since 2014, but in 2021 it was dramatically expanded to cover individuals making more than 400% of the federal poverty level. These enrollees had previously faced a steep “subsidy cliff,” whereby they had to pay the full price of their healthcare premiums. This expansion led to significant enrollment gains for children, Black and Hispanic populations, people living in rural areas, and part-time workers—all groups which have historically faced barriers to accessing affordable healthcare. While the PTC is no substitute for universal healthcare, its dismantling is a massive blow to ordinary people.
As of this January, those who relied on the PTC will have begun paying an average of nearly $2,000 a year just for their monthly healthcare premiums, and that’s not counting any of the other costs of healthcare like co-pays and medications. And that’s just the average; many enrollees are facing even steeper increases. For one single mom interviewed by PBS, her monthly premium payment is going from $85 a month to nearly $750—a 782% increase. Older Americans, who often require more medical care than younger populations, stand to suffer the most, with almost every state seeing monthly premiums increase by over $1,000 for Americans over 60. In a worsening economy, this will be downright deadly for tens of thousands of ordinary people.
Higher Prices For Everyone
At the end of 2025, around 1.2 million fewer people had signed up for plans under the ACA than in 2024, and it is expected that more will drop their coverage as cost burdens increase. Some analysts are estimating that around five million Americans will drop their ACA coverage under the pressure of higher premiums by the end of the year.
Anticipating the end of the PTC, the ghouls running these insurance companies reported last year that they will charge between 12 and 27% more for premiums in 2026. This is because the insurance industry relies on healthier individuals paying more in premiums than what they utilize for care, in order to “balance out” older and sicker people who typically receive services that cost more than what they pay in. With younger and healthier people dropping coverage because it’s too expensive, more sick and “high-cost” patients remain, and companies hike their prices. And then the cycle repeats.
So for the people who can afford to keep their ACA plan, or can’t afford it but have to make it work some way or else they’ll die, insurance costs will only go up in the coming years. This sounds inhumane to ordinary people, but it’s the logic of the profit-seeking capitalist system: if your entire goal is making more profits than you made last year, it doesn’t matter that needing medical care is not a choice. Real human lives get reduced to statistics and stamped as low- or high-cost by insurers to ensure they’re charging enough to see higher returns this year. Capitalism does not care how it tramples on people’s lives—which is why we have to fight to end it, along with its political puppets.
The Democrats Won’t Give Us Universal Healthcare
The callous disregard the Republican Party has for human life has been on display long before Trump’s first administration, but the Democrats are no better; they haven’t lifted a finger for healthcare reform since Obama was in office. In fact, the Democratic establishment has done everything it can to quell discontent around healthcare, crushing Bernie Sanders’ campaign for universal healthcare not once, but twice—with the latter taking place during the global COVID-19 pandemic.
Even the “progressive” wing of the Democratic Party has completely dropped the fight for universal healthcare. In late 2020, the Squad could have leveraged their power by withholding their vote for Nancy Pelosi unless she held a floor vote on Medicare for All. Despite broad support for this tactic, they refused. AOC argued that there was no point to staging a vote on Medicare for All only to lose it, and that progressives’ focus should be on “winnable” measures like a nationwide $15 minimum wage—which also did not happen!
And in 2024, the Kamala Harris campaign confirmed that her 2019 support for Medicare for All was a farce, telling the New York Times that she “no longer supported a single-payer health insurance program.”
If a Democrat wins the 2028 presidential election and Trump accepts the results, we still wouldn’t see the healthcare reform we need, including a return of the ACA tax credits. We need a mass working-class movement that includes both union and non-union medical providers across practices, their patients, and the broader community. Additionally, we can have no faith in the Democrats—working people need our own party now more than ever.
We Need A New Party: Lessons From Canada
A new, left, independent workers’ party is not some utopian impossibility. Canada’s healthcare system was won in large part thanks to workers and socialists in Saskatchewan, who decisively broke from the corporate political parties in 1932 and launched the Co-operative Commonwealth Federation (CCF), an independent labor-farmer party. The CCF was founded on a bold political program calling for the eradication of capitalism and for a socialist society. The demands in their 14-point manifesto included government-controlled economic planning, the socialization of finance, and free medical coverage to Canadians with government-run healthcare.
After 15 years of organizing community struggles and winning independent electoral campaigns, the Saskatchewan CCF formed the first democratic socialist government in North America in 1944. That same year the province saw another first: through grassroots movements, the Saskatchewan Hospital Services Plan was launched—the first universal, tax-funded hospital insurance program on the continent. By 1948, over 90% of the province was enrolled. By 1972, every Canadian province had universal public health insurance for both hospital and physician care.
However, today millions of Canadians are still underserved when it comes to healthcare. Worse still, Canada’s federal government has recently taken steps to erode the Interim Federal Health Program, which provides some medical and health benefits to people who have made refugee claims in Canada. Where refugees were once 100% covered, they will now have to pay more for prescriptions and “supplemental services” like dental, vision, and mental healthcare. These kinds of cuts swing open the door for wider attacks on healthcare and social services. And this is not unique—governments throughout the world are slashing away at state spending on healthcare and other parts of their social safety nets in favor of increased spending on defense.
This history shows that a fight for healthcare reform can yield important gains under capitalism—and it also shows that unless we fight to overthrow capitalism, these gains will be watered down if not clawed back completely.
We Can’t Stop At Healthcare: Fight For Socialism!
The $75 billion allocated to ICE in Trump’s Big Beautiful Bill last year could pay for the cost of ACA subsidies five times over. The $1.5 trillion “defense” budget for the 2027 fiscal year could cover subsidies for over a century. The government obviously has the money to maintain ACA subsidies; healthcare just isn’t a priority for either party to fund. That means our fight needs to be aimed directly at the billionaire class.
The capitalist system, which the ruling parties globally uphold, depends on the working class staying divided and squeezed by the astronomical cost of living; it counts on us being too beaten down to mount a fightback. But it is workers’ struggle, not politicians’ promises, that has won victories for the working class and most oppressed communities. We need to organize real organs of struggle in our workplaces, schools, and communities, not just against ICE and imperialist war, but for universal healthcare, fully-funded public schools, affordable housing, a minimum wage workers can thrive on, and more.
But as mentioned, we can’t stop there—we need to overthrow this whole rotten system. Only under a socialist society, where the economy is democratically run by workers in the interests of people and the planet, can we permanently end wars and state brutality and ensure that every person has the resources they need to thrive.
