Watch live: Johnson holds a press conference on day 27 of the government shutdown

WASHINGTON (AP) — The first caller to the town hall came on the phone with Maryland Rep. Andy Harris, leader of the conservative House Freedom Caucus, ready with a question about the Affordable Care Act. The caller said that her disabled cousin was at risk of losing the insurance he obtained under this law.

House Speaker Mike Johnson is expected to hold a press conference at 10 a.m. EST. Watch the live stream in our video player above.

“She is now looking at two or three times the premium she was paying for insurance,” said the woman, identified only as Lisa from Harford County, Maryland. “I would like you to explain to me what the Republican plan for health insurance is?”

Harris, a seven-term Republican, did not have a clear answer. “We think the solution is to try to do something to make sure all the bonuses go down,” he said, anticipating that “Congress will likely negotiate some solutions outside the scope of the agreement” later.

His uncertainty reflects a familiar Republican dilemma: Fifteen years after the Affordable Care Act was enacted, the party remains united in criticizing the law but divided on how to move forward. This tension has been highlighted acutely during the government shutdown as Democrats exploit rising insurance premiums to pressure Republicans to extend expiring subsidies for the law, often referred to as Obamacare.

President Donald Trump and GOP leaders say they would consider extending enhanced tax breaks that expire at the end of the year — but only after Democrats vote to reopen the government. Meanwhile, people enrolled in plans are already being notified of significant 2026 premium increases.

With town halls filled with frustrated voters and no clear Republican plan emerging, the issue appears to be gaining political strength as next year’s midterm elections approach.

“Premiums are going up whether they are extended or not,” said Republican Sen. Rick Scott. “Insurance premiums are going up because health care costs are going up. Because Obamacare is a disaster.”

“Plan Concepts”

At the heart of the shutdown — now in its fourth week with no end in sight — is a Democratic demand to extend the Affordable Care Act benefits passed in 2021.

Trump has long promised an alternative. “The cost of Obamacare is out of control, plus it’s not good health care,” he wrote on Truth Social in November 2023. “I’m seriously looking into alternatives.”

After being pressed about health care during the September 2024 presidential debate, Trump said he had “plan concepts.”

But nearly 10 months into his presidency, that plan has yet to come to fruition. “I absolutely believe the president has a plan,” Dr. Mehmet Oz, director of the Centers for Medicare and Medicaid Services, told NBC on Wednesday, but did not elaborate.

Republicans say they want a broader overhaul of the health care system, although it will be difficult to move forward with such a plan before next year. Party leaders did not specify how to deal with the expiring tax breaks, insisting that they will not negotiate the issue until Democrats agree to end the shutdown.

A September analysis by the nonpartisan Congressional Budget Office estimated that permanently extending the tax credits would increase the deficit by $350 billion from 2026 to 2035. The CBO projected that the number of people with health insurance would rise by 3.8 million people in 2035 if the tax credits were retained.

Asked Wednesday on CNN whether Republicans had a plan to address subsidies if the government reopens, House Speaker Mike Johnson said they had “proposals” that could be “ready immediately.”

He said: “It is a very complex issue, and it takes a long time to build consensus around it.”

A growing political issue

With notices about higher premiums now in mailboxes and the open enrollment period for health plans under the Affordable Care Act beginning on November 1, the political pressures are evident in Republican town halls.

In Idaho, Rep. Ross Fulcher told concerned callers that “government health care is the wrong way” and that “private health care is the right way.” In Texas, freshman Rep. Brandon Gill responded to a caller facing a sharp increase in insurance premiums by saying Republicans are focused on cutting waste, fraud and abuse.

Harris echoed a message shared by many in his party during the Maryland town hall, saying costs are “just getting back to where they were before COVID.”

But the number of people relying on health insurance under the Affordable Care Act has increased significantly since before the pandemic. More than 24 million people were enrolled in Marketplace plans in 2025, up from about 11 million in 2020, according to an analysis by the health care research nonprofit KFF.

Sarah from Middleville, Michigan, told Rep. John Moolenaar during his City Council meeting that if health insurance premiums rose by as much as 75%, most people would likely go without health care. “So how do you treat that?” I asked.

“We have time to negotiate, come up with a plan moving forward, and I think that’s something that can happen,” responded Moolenaar, who represents a district he won handily last year.

Some Republicans have expressed urgent concern. In a letter sent to Johnson, a group of 13 House Republicans wrote that the party should “immediately shift our focus to the growing crisis of health care affordability” once the shutdown ends.

“Although we did not cause this crisis, we now have the responsibility and opportunity to address it,” the lawmakers wrote.

Some Republicans dismiss projections that Affordable Care Act premiums would more than double without the subsidies, calling them excessive and saying the law has fueled fraud and abuse that must be curbed.

Many Democrats attributed their ability to flip the House in 2018 during Trump’s first term to the GOP’s attempt to repeal Obamacare, and they expect a similar result this time around.

About 4 in 10 American adults say they trust Democrats to do a better job on health care, compared with about a quarter who trust Republicans more, a recent AP-NORC poll showed. According to the poll, about a quarter of them do not trust either party, and about 1 in 10 trust both equally.

An internal battle looms among the Republican Party

Even as GOP leaders pledge to discuss ending subsidies when the government opens, it is clear that many Republican lawmakers are strongly opposed to an extension.

“At least among Republicans, there is a growing sense that just maintaining the status quo is very destructive,” said Brian Blase, president of the Paragon Health Institute and a former health policy adviser to Trump during his first term.

Michael Cannon, director of health policy studies at the libertarian Cato Institute, said he is working with several congressional offices on alternatives that would allow the subsidies to end. For example, he wants to expand the Affordable Care Act exemption granted to US territories to all 50 states and reintroduce Trump’s first-term policy that gave Americans the ability to access short-term health insurance plans outside the Affordable Care Act marketplace.

Cannon declined to name the lawmakers he works with, but said he hopes they act on his ideas “sooner rather than later.”

David McIntosh, president of the influential conservative group Club For Growth, told reporters Thursday that the group “urged Republicans not to extend benefits in the age of the coronavirus.”

“We have a big spending problem,” McIntosh said.

“I think most people would say, ‘Well, I’ve had a lot of fun during COVID,’” he said. “But now it’s business as usual, and I have to pay for health care.”

Swenson reported from New York.