Rising Obamacare premiums and disappearing subsidies mean that millions of consumers will soon have to pay significantly more for their health insurance. Fortunately, President Trump already ran a six-year test that demonstrated that restoring the freedom to choose non-Obamacare plans can provide access to quality, affordable coverage without destabilizing Obamacare — or expanding it, as some Senate Republicans propose.

Come January, 24 million Obamacare enrollees will see their premiums rise an average of 26 percent. Of those, 22 million will simultaneously see their premium subsidies shrink or disappear. Middle-income enrollees currently paying, for example, 0 to 10 percent of an already excessive premium may have to pay 10 to 20 percent of an even larger premium. Many wealthy enrollees will have to pay 100 percent of the new, larger premium.

This unfortunate scenario is entirely of Democrats’ making. Obamacare’s rising premiums are a consequence of its basic architecture.

Obamacare operates on the principle that the government should deliberately increase health insurance premiums for the majority of consumers — to about double what they would otherwise pay — in order to subsidize the minority with expensive medical conditions. Doubling people’s premiums, however, tends to make them not want to buy health insurance.

To address that problem, Obamacare includes premium subsidies for moderate-income households, including families of four earning up to $128,000 per year. Current law will spend some $1.3 trillion on those subsidies over the coming decade, shifting the burden of Obamacare’s hidden taxes from premium payers to taxpayers. In 2021, Democrats created additional, temporary subsidies for enrollees earning up to $600,000 annually; those “enhanced” subsidies expire this month.

Rather than admit that all these taxes and subsidies have failed to make health insurance affordable, Democrats want to spend an additional $488 billion over the next decade to make those temporary subsidies permanent.

Not a single Republican voted for the hidden taxes driving Obamacare premiums skyward, or the subsidies that have failed to tame those premiums, so it was a surprise when White House officials nearly endorsed extending the “enhanced” subsidies for two years, which would effectively make them permanent. Fortunately, they retreated following blowback from congressional Republicans.

Another surprise was that the White House nearly endorsed giving some of that $1.3 trillion in current-law subsidies directly to enrollees rather than insurance companies. It’s a nice thought, but that too would increase Obamacare spending. Cash is more attractive than health insurance, which would lead more people to claim the subsidy. The number of people potentially eligible for Obamacare’s premium subsidies is three times the number currently receiving them.

Like the faux–repeal bill from which Senator John McCain (R., Ariz.) saved them in 2017, it would also blow up in Republicans’ faces. Obamacare’s costliest hidden taxes are those that increase premiums for the healthy. “Community rating” price controls simultaneously reduce premiums for the sick, but at the cost of creating powerful incentives for adverse selection and to ration care for the sick. The fact that Obamacare’s subsidies can only go toward health insurance dampens those incentives. Were Republicans to turn those premium subsidies into cash subsidies, then fairly or not, everyone would blame Republicans for the adverse selection and rationing that would follow.

Two powerful Senate committee chairmen — the Finance Committee’s Mike Crapo (R., Idaho) and the Health, Education, Labor, and Pensions Committee’s Bill Cassidy (R., La.) — managed to combine both bad ideas by proposing a whole new Obamacare entitlement: cash payments into Obamacare enrollees’ health savings accounts (HSAs). Call it “Obamacash.” One imagines tears of laughter from Obama that Republicans are proposing to expand his signature law.

President Trump has already shown Republicans how to provide relief from Obamacare, without expanding or disrupting Obamacare. Making permanent the relief Trump implemented in 2018 would combine better policy with simpler, stronger messaging.

In 2010, Congress and President Obama exempted so-called “short-term” health insurance from Obamacare’s hidden taxes. In 2018, Trump clarified that federal law allows those plans to offer two consumer protections: 36-month contract terms, plus “renewal guarantees” that ensure enrollees who get sick can reenroll in a subsequent plan at low, healthy-person premiums. Multiple federal courts agreed that federal law allows both.

The nonpartisan Congressional Budget Office found that those plans made comprehensive coverage — often with lower deductibles and broader choice of providers than Obamacare plans — available at premiums 60 percent below the lowest-price Obamacare plans. Importantly, those plans did not share Obamacare’s incentives for adverse selection and rationing. In 2024, President Biden unwisely revoked the Trump rule.

The simplest way to provide relief to Obamacare enrollees — rather than expand Obamacare or tinker with its volatile architecture — is to make Trump’s clarification a permanent part of federal law, so future presidents cannot revoke it like Biden did. Most Obamacare enrollees could afford better coverage without need of a government subsidy.

Many Democrats fear that giving consumers this freedom would undermine Obamacare for those who need it. A full-scale test of this idea showed that didn’t happen. While the Trump rule was in place from 2018 to 2024, Obamacare premiums stabilized and enrollment grew. Premiums spiked only after Biden revoked it.

Obamacare fared well under the Trump rule. It could remain in place for those who want it. Those who don’t want Obamacare should have the option of better, more affordable health insurance.

Congress needs to do its job. Make the Trump rule permanent.