Republicans in the swing district are bracing for political fallout if health care subsidies end

ALLENTOWN, Pa. (AP) — Republicans in key battleground districts in the U.S. House are working to contain the political fallout that could come when thousands of their constituents face higher bills for health insurance coverage obtained through the Affordable Care Act.

For a critical segment of the Republican majority, the imminent expiration of so-called enhanced tax breaks after December 31 is a pressing concern as they are likely to face headwinds in the 2026 midterm elections that will be crucial to President Donald Trump’s agenda.

Read more: The White House’s health care proposal faces familiar divisions in the Republican Party

One of them is U.S. Rep. Ryan McKenzie, Republican of Pennsylvania, whose win for the Allentown-area seat last year was among the narrowest in the country.

McKenzie is part of a bipartisan group pushing for an eleventh-hour compromise, calling for an extension of tax breaks that try to fix perceived flaws and lower health care costs. But that push is elusive because of the Republican Party’s entrenched opposition to the health reform known as “Obamacare.”

“I think we need to deal with the reality of where we are now, and even if you have a broken system, that doesn’t mean you shouldn’t provide or provide relief to individuals who are dealing with those high costs right now,” McKenzie said in an interview with The Associated Press.

Democrats have laid the groundwork, starting with the shutdown battle this fall, to make the health care issue a central focus of next year’s campaigns.

Read more: 4 Tips for Navigating Higher ACA Health Care Premiums

The party’s strategy to seize the House majority centers on pinning higher grocery, health insurance and utility bills on Trump and Republican policies.

Republicans are torn about the extension

In Washington, Republicans from competitive House districts have authored or signed bills that would temporarily extend tax breaks. A new bipartisan proposal unveiled Thursday has received support from nearly 15 Republicans and 20 Democrats so far.

“I have 40,000 people in my district who depend on this health care, and doing nothing to prevent their premiums from going up is wrong,” said U.S. Rep. Gene Keegans, R-Va., one of the plan’s sponsors.

Thirteen Republicans — including McKenzie — signed a letter in late October to the Speaker of the House, Rep. Mike Johnson, R-Los Angeles, encouraging a temporary extension of the tax breaks, saying that allowing them “to lapse without a clear path forward would risk real harm to those we represent.”

He watches: Johnson faces growing frustration with Republicans as key issues reveal rifts

Johnson did not commit to voting on a short-term extension before January 1 and dismissed the looming insurance 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 people who have no other health insurance options through their work.

Many benefit from subsidies that reduce their direct costs. These reliefs include enhanced tax credits, which were added and then extended under Democratic President Joe Biden when his party had the majority in Congress.

Some Republicans — including McKenzie — are voicing support for an extension while warning that changes must be made. The first is to eliminate fraud in insurance brokers. The other issue is the withdrawal of subsidies provided to those with higher incomes.

Time is running out

U.S. Rep. Kevin Kelly, one of the California Republicans whose electoral districts were redrawn for Democrats, has sponsored a bill to extend the tax breaks for two years. His bill would also impose an income eligibility cap to exclude those with higher incomes.

Kelly said the current system is not working, but there is not enough time to make systemic reforms before millions of Americans suddenly pay double their premiums.

Read more: 3 things to watch as Congress winds down the year

U.S. Rep. Jeff Van Drew, R-Texas, also has a bill to temporarily extend the credit, and said allowing the subsidy to lapse would make it harder for Republicans to maintain their majority next year.

“People say, ‘Well, there aren’t that many people,’” Van Drew said. “The type of elections we have in the midterms in multiple districts will be determined by one or two points. They will be close. They will be close, and they are important. They are certainly important politically.”

U.S. Rep. Richard Hudson of North Carolina, head of the House Republicans’ campaign arm, said the tax breaks would not be “decisive” in next year’s election when other matters are likely on voters’ minds.

Democrats will run on affordability

But U.S. Rep. Susan DelBene of Washington state, who heads the House Democrats’ campaign arm, said Republicans in swing districts would not be able to distance themselves from the expiration of the tax breaks.

“The No. 1 issue across the country is affordability and health care is a key part of that,” DelBene said.

He watches: Trump says the word “affordability” is a “con job” by Democrats

The Congressional Budget Office projects that an additional 3.8 million people will be uninsured in 2035 if the tax credits are not extended. But the tax breaks also come with a cost: extending them would increase the deficit by $350 billion over the next decade.

The expiration of the tax credits means enrollees will receive annual premiums more than double — from an average of $888 in 2025 to $1,904 in 2026, according to the health care research nonprofit KFF. This is an increase of 114%.

The size of the increases varies by state, age and income, and will be most extreme in the McKenzie area, according to state data, which puts the average premium increase at 178%.

A core field of Democrats is shaping up for the nomination to challenge McKenzie. They say they’re hearing from people who are struggling to afford rising insurance premiums.

Read more: The shutdown deal does not extend health benefits that expire. What happens to them now?

One of those Democrats, Ryan Croswell, said rising insurance costs are a “violation of promises” made by Trump, Republicans and McKinsey. Another Democrat, Carol Obando Dearstein, called the impending expiration a “crisis of (McKinsey’s) making.”

McKenzie says he has made it clear repeatedly that he supports an extension, but “I’m not the speaker, I don’t set the calendar or the agenda. I’m not the leader, and I can’t call bills.”

Registrants face difficult choices

In the McKenzie area, more than 20,000 people received the enhanced tax credits in 2025, according to state data. He won his race last year by one percentage point, or about 4,000 votes.

One of those 20,000 people in the Mackenzie area is Patrick Visconti, who switched to a low-premium, high-deductible plan because he couldn’t afford to keep his plan with the premium more than doubling from less than $200 to more than $500 a month.

Visconti, 59, a self-employed engineer and bus driver, said the plan he chose was “bad coverage.”

“I’d rather pay $200 a month,” Visconti said. “But I can’t get anything for $200.”

Lynn Weidner, a home care worker in the Mackenzie area who works nearly 80 hours a week, said her $400 premium will rise to $680. But she said she was leaning toward choosing the plan because she suffers from various conditions — including iron deficiency — that require regular medical care.

“So I’m trying to find places where I can save money so I can afford my insurance by January, which is stressful,” Weidner said.