Dear Chairman Arrington, Ranking Member Boyle, and Members of the Committee,

We are Romina Boccia (Director of Budget and Entitlement Policy) and Michael F. Cannon (Director of Health Policy Studies) from the Cato Institute. We would like to thank the Committee on the Budget for convening this Hearing: “Reverse the Curse: Skyrocketing Health Care Costs and America’s Fiscal Future”, on January 21, 2026, and for providing the opportunity to express our views regarding this topic. We are writing to propose specific reforms Congress can pursue to reduce federal health spending, restore choice to consumers, and lower health care prices.

Obamacare

Repeal the Affordable Care Act

Obamacare doubles or triples premiums for most enrollees, reduces plan choice, and creates incentives to restrict access to care for the sick. Repealing the ACA would reduce federal spending, restore the freedom of individuals to make their own health insurance and health care decisions, reduce premiums for most individuals by 50 percent or more, force insurers to compete on and improve quality, reduce federal deficits and debt, reduce political conflict, and devolve authority over government assistance for the sick to the states, as the US Constitution provides.

Make Obamacare Relief Universal and Permanent

When Obamacare restricted access to affordable coverage, Presidents Obama and Trump provided relief by removing barriers to Obamacare-exempt plans. The Congressional Budget Office found such plans offer comprehensive coverage at premiums about 60 percent lower than the cheapest Obamacare options. Making both types of relief universal and permanent would expand affordable insurance without expanding Obamacare. In addition, doing so would move on-budget many of the implicit taxes and subsidies that Obamacare currently places off-budget.