The following is a lightly edited transcript of the December 18 episode of the Daily Blast podcast. Listen to it here.
Greg Sargent: This is The Daily Blast from The New Republic, produced and presented by the DSR Network. I’m your host, Greg Sargent.
In a big blow to House Speaker Mike Johnson, four House Republicans just joined with Democrats to force a vote next year on an extension of Affordable Care Act subsidies. Those Republicans who are vulnerable in the midterms are hoping this helps save their seats next year. But will it? The problem for Republicans is that what’s happening now is almost certain not to save the subsidies, which will leave them on the wrong side of the health care issue when they can least afford it. New polls today underscore the depth of the party’s hole on healthcare and the economy. And Mike Johnson’s reaction to all this was unintentionally revealing as well. We’re talking about all of it with Grace Segers, who writes really well about Congress and policy as a staff writer for The New Republic. Grace, good to have you on.
Grace Segers: Thanks so much for having me.
Sargent: So let’s start here. Four Republicans just joined this discharge petition to force a vote in 2026 on a three-year extension of the Affordable Care Act subsidies that were expanded under Joe Biden and are expiring. Grace, this expiration is going to hit millions of people, and yet it’s highly likely that even if this House bill passes, it won’t get into law. Can you explain all this?
Segers: So today we saw four House Republicans sign onto a discharge petition, which is basically a way for them to get around the House process and force a vote on legislation that would allow the extension of these subsidies. Like you said, this is a really big deal for millions of Americans who rely on the Affordable Care Act marketplace to enroll in health care.
But the issue here is that even if and when it does pass in the House next year, first of all, the subsidies will have already expired. So that means that millions of people are going to be affected. And then second of all, Republicans still control the Senate and there’s still the filibuster in place. So it probably wouldn’t pass in the Senate either.
So in a sense, this is more of a way for those House Republicans to make it look as if they are doing something on the issue. But it’s hard to see whether this would have an actual policy impact.
Sargent: Well, so let’s talk about these four Republicans. They’re Brian Fitzpatrick, Rob Bresnahan Jr., Ryan Mackenzie—those three are from Pennsylvania. And then there’s Mike Lawler of New York. They’re vulnerable in 2026. They’ve been trying to get the House to vote on an extension of the subsidies because, as you say, they really need to be on the right side of this issue. Mike Johnson’s been refusing. Now listen to how Mike Lawler reacted to this.
Mike Lawler (voiceover): I am pissed for the American people. This is absolute bullshit. And it’s absurd that we are in a body with 435 members. Everybody has a responsibility to serve their district, to serve their constituents.
Sargent: And listen to this from Representative Kevin Kiley, also a Republican, who’s speaking here about Johnson’s refusal to allow that vote.
Kevin Kiley (voiceover): That’s a failure of leadership. I mean, we have, you know, members on both sides who believe this is an urgent issue, and it is for all of our members in terms of what their constituents are going to have to deal with at the start of the new year. So what’s wrong with having a vote?
Sargent: So clearly some of these Republicans think this will insulate them from constituent blowback if and when people’s premiums spike big-time. But I really wonder if that’s true.
As you say, they’re going to spike anyway. But I think also the entire Republican Party is likely to get most of the blame for what’s happening. And that just is going to fuel a desire to throw out Republicans.
You add onto that the typical midterm patterns, which just work against the party that is in control of the White House. And I don’t know that even voting for the extension is enough to protect the vulnerable ones. What do you think?
Segers: It’s of course tricky to say. I think that we should note that all of those four, with the exception of Brian Fitzpatrick, did vote for the One Big Beautiful Bill Act over the summer—the law that cut Medicaid and made a lot of changes to social policy. And we know that Republicans generally fall in line, as they did over the summer with that legislation.
So we know that health care is generally something that Republicans are considered to do more poorly on. But I will also note that even though, you know, conventionally with the way midterm trends are going, it’s more likely that Democrats recapture the House, perhaps, than House Republicans hold on to it.
But I was just looking at a Quinnipiac poll out today that showed that Democrats in Congress do have the lowest approval rating that they’ve had since 2009 right now, with only 18 percent of Americans—registered voters—supporting how they’re doing right now.
So I think we need a little bit more nuance here, other than just, “Americans are going to be mad at Republicans,” because I think that’s true. But I think it’s not quite as clear-cut as in, you know, maybe that then they will turn to Democrats instead.
Sargent: Yeah. The Democrats have a lot of work to do in convincing voters that they’re going to be better. I just think that the way midterms function generally is [that] it’s a referendum on the party in power. So I guess we’ll see if the miserable numbers for Democrats undo that structural fact. Let’s listen to how Mike Johnson responded to this. He was asked by a reporter if the fact that the discharge petition now has enough signatures means he’s lost control of the House. Listen to this.
Mike Johnson (voiceover): We have the smallest majority in U.S. systems. These are not normal times.
Sargent: So, Grace, here Johnson says, “I have not lost control,” and yet it appears that he’s going to be unable to prevent a vote on extending the ACA subsidies. Can you walk us through why he wanted to block this vote in the first place? There was a pretty large bloc of House Republicans that absolutely didn’t want to extend the subsidies, right?
Segers: I do think that we shouldn’t overlook the ideological element here. So Mike Johnson is fundamentally a very conservative Republican, and a lot of the more conservative Republicans in the House were very against, first of all, just the ACA as a whole on principle, but certainly against extending anything to do with the ACA and spending any kind of money on the ACA.
So I actually do think that is probably his biggest motivation in preventing—or attempting to prevent—this from coming to a vote: simply because he fundamentally disagrees with the ACA and doesn’t believe that any more federal money should be spent on it.
That said, we have seen how he has an incredibly thin majority and lots of different ideological blocs sort of vying for power. That’s been true for pretty much every speaker that we’ve seen in the modern era, but I do think that his narrow majority, as he often complains about, means that it makes things more difficult for him.
And you kind of saw that in the fall during the government shutdown, when the House was out for several weeks because it is easier to keep the House out of session than to have them in session and not be in control of what they do.
Sargent: Well, I want to pick up on what you just said there, which is that Mike Johnson is ideologically opposed to the subsidies getting extended. Clearly, he calculated that if it did get a vote, it would pass, right?
I mean, this is the thing. What’s been revealed here is that the Republican position is very unpopular—so unpopular that, finally, a bloc of moderates had to break with Mike Johnson and the Republican conference to join the Democrats, right?
Segers: I do think that Republicans realize how much of a critical issue this is. We have seen Trump pollsters—like Tony Fabrizio, I’m thinking of, but we have had Trump pollsters—look at this issue and say, “This is going to be a big issue for Republicans,” because it’s not just, as with Medicaid, very low-income Americans who are going to be affected. It is everyone who participates in the ACA marketplace.
So that includes lower-middle- and middle-income Americans, and in particular, older Americans are going to be affected and see their premiums hike by a dramatic amount as well. And so I think that Republicans recognize, as Democrats recognize, that this is an issue that is not going to go away. And particularly when we see those premiums go up next year, the policy consequences for Americans will be very real.
Sargent: Well, let’s talk about some of the new polling because it underscores your point really well. A new NPR/Marist poll has Trump’s approval at a new low of 36 percent on the economy. Fifty-four percent of Americans say they’re concerned that they won’t be able to pay for health care in the next year, and that includes 55 percent of independents.
One thing that’s striking to me about this whole situation is that health care is now even more of an economic issue than it sometimes is. It’s sometimes—I think wrongly—put in a separate bucket from the economy in a funny way in the minds of pundits and in our discourse.
But with “affordability” being the big issue right now, health care costs bleed into economic issues in a major way. And a majority—[a] solid majority—of Americans say that they’re not going to be able to pay for health care, and an even more solid majority of independents [say the same]. That’s pretty rough, isn’t it?
Segers: Well, when you think about all of the folks who aren’t going to be able to afford their health care next year, that could have really significant consequences where they may choose to look for a different plan that has a lower premium, but that has higher deductibles or copays.
And that could also increase costs, or they could go without health insurance altogether. They could choose to drop their coverage altogether. And then what that means is if you have primarily healthy people dropping their health insurance, then the risk pool gets greater for the existing people who need health insurance, and that makes premiums go up even more.
So not only are we seeing a cost increase in the immediate term, it’s probably only going to compound as more people choose to drop health care. And of course, when people choose to drop health insurance, that means people are sicker.
Sargent: Right. We’re probably going to see a spike in the uninsured rate. And as you point out, this is going to affect a lot of people beyond the millions who are counting on the subsidies, correct?
Segers: So the ACA marketplace enrollees are the ones who are going to be the most immediately affected. But when one aspect of the American health care system is undermined or put at risk, then the rest of the health care system is as well. So everyone is seeing health care costs go up next year.
It’s not just people who are ACA enrollees; everyone is going to be seeing increased costs. And as insurers make decisions based on who is enrolling through the ACA marketplace—and then also based on cuts to Medicaid that we have seen, aren’t going into effect for a couple of years but [are] still very much in mind—how insurers behave, how hospitals behave, how any kind of health center behaves depends very much on what’s going to be happening next with the ACA and with Medicaid.
So even though directly it’s primarily going to affect enrollees, there are ripple effects throughout the rest of the American health care system that will impact everybody.
Sargent: Yeah. And I want to bring up this Quinnipiac poll; you mentioned it earlier. It has Trump’s approval on health care at 34 percent to 59 percent disapproving. It also has Democrats with a 51 percent to 37 percent advantage on which party can do a better job handling the health care issue.
So, you know, acknowledging your point about the dismal numbers for Democrats, it still doesn’t prevent them from being trusted on this issue by double digits over Republicans.
And I think if I’m hearing you correctly, it sounds to me like we really can’t even predict how bad the damage is going to be over time throughout the next year, and we’ve got these terrible numbers for Republicans even before that damage has set in, right? How much worse does this get?
Segers: Well, when you look at polling, just generally speaking, Democrats do tend to do better on issues such as health care. We know that. And then Republicans tend to do better on issues such as immigration, and it seems in recent polling as if those gaps for Republicans are narrowing.
But I do think it’ll be interesting to see whether health care remains top of mind for voters over the next year, because if it does—and as we generally know, Democrats are seen as doing better on health care—then that could be good for Democrats. At the same time, I do think that there’s just a lot of fatigue all around in general with Congress, with politics, with politicians.
And in terms of structural trends, I do think that Democrats have the advantage when it comes to next year. But it is also just [that] things are bad with the economy. People are hurting. And sometimes you just don’t know how they are going to interpret that when they go to the ballot box, particularly not [a] year in advance.
Sargent: So how bad do you think the health care system is going to get? Are we going to see a spike in the uninsured rate? Are we going to see a lot of suffering? Are we going to see a lot of rural hospitals really struggling?
It seems to me that we’re looking at a bit of a perfect storm of factors here that are really bad. And we were kind of on a track to something good with the Affordable Care Act—at least, you know, at certain times over the last few years. The big story was kind of that it was lowering the uninsured rate, which was a real progressive achievement.
But now, if I’m hearing you correctly, we’re headed for real trouble throughout the system in ways that are going to cause a lot of suffering. Is that right?
Segers: Yeah, none of this exists within a vacuum. So with regard to the ACA specifically, since these enhanced subsidies were introduced in 2021, participation in the ACA marketplace has spiked dramatically.
And as I was saying, people may choose to drop coverage overall. The Congressional Budget Office has expected that over the next 10 years, this change could result in 2 million people losing their insurance. Other people—or other organizations—have estimated even greater numbers than that.
And then when you look on top of that with the cuts to Medicaid, that also is going to have a dramatic effect on the insured rate, particularly as people may not be able to meet new work requirements.
So I do think that this is somewhat of a perfect storm in terms of a health care crisis over the next couple of years, because it’s not just losing these enhanced subsidies; it’s also the changes that we’re seeing to Medicaid.
Sargent: Yeah, looks to me like it’s going to be really, really terrible. Grace Segers, thanks so much for coming on with us. That’s some pretty brutal stuff, though.
Segers: Thanks for having me.