Why Washington’s health care debate never really goes away

The president was barely a year into his administration when a health care debate began to consume Washington. On Capitol Hill, partisan divides formed as many Democrats pressed for guaranteed insurance coverage for a broader swath of Americans while Republicans, buttressed by medical industry lobbying, warned about cost and a slide into communism. The year was 1945 and the new Democratic president, Harry Truman, tried and failed to persuade Congress to enact a comprehensive national health care program, a defeat Truman described as the disappointment of his presidency that “troubled me the most.” Since then, 13 presidents have struggled with the same basic questions about the government’s role in health care, where spending now makes up nearly 18% of the U.S. economy. The fraught politics of health care are on display again this month as millions of people face a steep rise in costs after the Republican-controlled Congress allowed Affordable Care Act subsidies to expire . While the subsidies are a narrow, if costly, slice of the issue, they have reopened long-festering grievances in Washington over the way health care is managed and the legacy of the ACA, the signature legislative achievement of President Barack Obama that was passed in 2010 without a single Republican vote. “That’s the key thing that I’ve got to convince my colleagues to understand who hate Obamacare,” said Sen. Bernie Moreno, R-Ohio, who is leading a bipartisan group of lawmakers discussing ways to extend some of the subsidies. “Let’s take two years to actually deliver for the American people truly affordable health care.” Democrats have heard that refrain before, and argue Republicans have had 15 years to offer an alternative. They believe the options being discussed now, which largely focus on allowing Americans to funnel money to health savings accounts, do little to address the cost of health care. “They’ve had a lot of time,” said Rep. Steny Hoyer, the Maryland Democrat who was House majority leader during the ACA debate. And with that, welcome back to the health care debate that never seems to end. The challenge of reaching consensus The often-tortured dynamics surrounding health care have remained remarkably consistent. Obamacare dramatically expanded coverage but remains — even in the minds of those who crafted the law — imperfect and more expensive than many would prefer. And Washington seems more entrenched in stalemate rather than marching toward a solution. “People hate the status quo but they’re not too thrilled with change,” Rahm Emanuel said as he reflected on the arc of the health care debate that he has watched as a top aide to President Bill Clinton , chief of staff to Obama and Chicago mayor. “That’s the riddle to the politics of health care.” Major reforms inevitably run into a health industry — a broad group of interests ranging from pharmaceutical and health services companies to hospitals and nursing homes — that spent more than $653 million on lobbying in 2025, according to OpenSecrets, which tracks political spending. “Any time you try to...

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