The United States remains locked in a long-standing health care debate as millions face steep cost increases after Congress allowed Affordable Care Act subsidies to expire. President Harry Truman tried and failed to persuade Congress to enact a comprehensive national health care program in 1945—a defeat he described as the disappointment of his presidency that “troubled me the most.” Since then, 13 presidents have struggled with the same basic questions about government’s role in health care, which now makes up nearly 18% of the U.S. economy.
The ACA, passed in 2010 without a single Republican vote, dramatically expanded coverage but remains imperfect and more expensive than many prefer. Republicans have spent 15 years opposing the law, with Trump calling for repeal as early as 2011. During his 2024 debate against Kamala Harris, Trump referred to “concepts of a plan.” On Thursday, he outlined a proposal titled “The Great Healthcare Plan,” which would not repeal the ACA but would focus on lowering drug prices and providing options for Americans to fund health savings accounts.
The health industry spent more than $653 million on lobbying last year, according to OpenSecrets. A KFF poll conducted in September 2025 found about two-thirds of Americans have a favorable view of the ACA, putting Republicans in a political bind. A record 24 million people were enrolled in the ACA last year, though fewer appear signing up this year as expired subsidies increase costs. In the most famous repeal effort, Senator John McCain cast the deciding vote in 2018 to keep the legislation in place. Even ACA architects acknowledge problems: former Senator Max Baucus said “bending the cost curve has not bent as much as we’d like.”
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.citizensvoice.com/2026/01/15/health-care-politics/