Despite persistent effort from both major parties, disagreement continues over the role of government in providing health care.
Obamacare had problems even before it launched in 2014. Marketplace websites were glitchy during the open enrollment period, frustrating many would-be customers.
Sweeping changes ushered in by the Affordable Care Act, the law creating Obamacare, all but guaranteed that premiums would increase—which they did by 23 percent in the program’s first year.
Even so, public opinion swung in favor of Obamacare starting in 2017 and remains positive, according to KFF Health Tracking polls.
More than 24 million people were insured through the program by 2025.
And insurers learned to thrive under the new rules, more than doubling annual revenue to $1.1 trillion and consistently generating a profit between 2014 and 2024.
Problems do persist, however.
Premiums have more than doubled over 12 years. Some consumers have only a few plans to choose from. And flaws in the program’s design continue to waste taxpayer dollars.
Lawmakers on both sides of the aisle have proposed solutions, many with bipartisan support. Yet permanent reform remains elusive.
The reason may have less to do with the ideas themselves and more to do with the most persistent disagreement between Republicans and Democrats: the role of the federal government.
Here are three commonly proposed remedies for problems within Obamacare, and why those problems remain.
1. Increase Plan Options
Of the more than 1,100 health insurers doing business in the United States, about 10, on average, offer plans through Obamacare in each state. About 5 percent of Obamacare users have only one or two insurers to choose from.
“Obamacare created a system that left American families with fewer choices,” said Sen. Rick Scott (R-Fla.), who proposed legislation to improve Obamacare in 2025.
Scott’s proposal would have allowed consumers to buy health insurance across state lines, which is now prohibited by most states with limited exceptions.
Five years ago, Sens. Tim Kaine (D-Va.) and Michael Bennet (D-Colo.) proposed allowing more choice by allowing consumers to opt into Medicare in counties where fewer than three insurers offered Obamacare plans. That plan, called Medicare X, later expanded to other counties with high-cost plans and few options.
Bennet and Kaine said the plan would both reduce costs and offer health coverage to people with few options. The plan was introduced in 2021 and again last year.
Others have suggested broadening the availability of catastrophic plans, which have low premiums but high deductibles.
That proposal and Scott’s proposal had been suggested by Democrats in 2017.
Still others have proposed allowing insurers to offer short-term health insurance plans through Obamacare. These three-month to six-month plans are popular with people between jobs or in a waiting period for employer-sponsored insurance.
“Short-term plans typically offer far lower premiums, substantially broader provider networks, and greater overall value for many middle-class families,” Brian Blase, president of Paragon Health Institute, said.
None of these ideas received a vote in Congress.
Conservatives were skeptical of the Medicare X proposal, seeing it as a step toward socialized medicine.
“Democrats claim that they just want to offer another health insurance choice. But Medicare X would simply nudge us along toward the Democrats’ endgame: a complete government takeover of the health insurance system,” Sally C. Pipes, president and CEO of Pacific Research Institute, wrote on the think tank’s website in 2024.
Left-leaning politicians and analysts have been skeptical of any plan that would offer what they see as inferior health coverage through Obamacare, including short-term insurance and catastrophic plans.
“Short-term coverage is not community-rated (that is, people can be charged more based on their health status, gender, or other factors) and it typically does not cover preexisting conditions,” Mark A. Hall and Michael J. McCue wrote in a 2022 article for The Commonwealth Fund.
