Moderate House Republicans who’ve been battling with their party over the imminent Obamacare cliff say the consequences — for people’s lives and the GOP’s political hopes — are dire.
That warning is about to hit home.
Rising health care costs and affordability issues are set to be defining topics in the 2026 battle for the House.
Yet the GOP-controlled Congress will still let ACA enhanced premium tax credits expire Dec. 31. Insurance premium costs will soar for millions of Americans, and many will be forced to forgo health care coverage next year.
This threat led four House Republicans to break with their party this week and sign onto House Minority Leader Hakeem Jeffries’ discharge petition for a three-year clean extension of the subsidies.
Two of the four GOP lawmakers are freshmen — Pennsylvania Reps. Rob Bresnahan and Ryan Mackenzie — making it even more striking they were willing to buck their leadership so publicly. These Republicans both flipped purple seats in Pennsylvania that will be among the most competitive in the country in 2026.
The rebels. Mackenzie and Bresnahan each said in interviews that they won their seats by running on affordability and cost issues.
“In 2024, the main topic that we talked about on the campaign trail was affordability,” Mackenzie said.
We asked Bresnahan if he feared retribution from GOP leaders. Bresnahan responded that his decisions reflected the realities back home:
“We were one of the four flip seats… We beat a 12-year, six-term ranking cardinal appropriator in order to preserve the majority in the House. So I think when you weigh all of the different extenuating factors together — I know my district, I know my home, I know my people.”
The financial reality for people in these districts looks grim.
With the enhanced ACA subsidies expiring, a 60-year old couple in Bresnahan’s district making $85,000 will see their premiums rise 325% on average for a typical plan next year, according to KFF data. A 40-year-old making $32,000 would see costs rise 210%. The numbers in Mackenzie’s district are similar, with a 60-year-old couple facing a 345% spike.
Part of the challenge for these Republicans is that Democrats are already hammering them over hundreds of billions of dollars in cuts to Medicaid spending from the One Big Beautiful Bill Act.
“I think if [Democrats] were accurately characterizing this legislation… the voters that I was elected by would be fully supportive,” Mackenzie said.
