For years, Republicans have pledged to repeal Obamacare and replace it with a suitable alternative. Now there is an idea on the table that can complete that promise. The idea will use market forces to bring down the cost of healthcare for all.
Obamacare is a problem. The law has imposed billions in costs on taxpayers through increased premiums. There is a way to bring premiums down without flooding the market with more taxpayer dollars. Without true healthcare reform legislation, taxpayer-subsidized spending to health insurance companies will get exponentially higher. When you give health insurance companies a blank check, backed by taxpayers, health insurance inflation is the result. It is a simple concept that if you don’t negotiate prices, health insurers will take advantage of the situation.
Back in 2024, the Joint Committee on Taxation (JCT) released a study that a Biden Administration proposal to permanently extend expanded Obamacare subsidies would cost taxpayers $383 billion over the next ten years. This includes subsidies to high-income individuals who don’t need the subsidy. They pointed out that in 2019, Obamacare subsidies cost the taxpayer $57 billion. Fast forward to 2024, and they cost $125 billion. The cost curve is expected to continue to go up if there are no reforms to the system.
This debate is occurring at a time when the United States federal government is carrying $38.4 trillion in collective debt, with a debt for Fiscal Year 2025 (that ended at the end of September) estimated at $1.8 trillion. Debt has become a serious national security issue because our nation can’t defend itself if it can’t fund a robust military, and our economy continues to suffer from inflation caused by out-of-control federal government spending. Increased federal spending on healthcare is one cause.
Senator Rand Paul (R-KY), my former boss, has an excellent idea that has been well-received by President Donald J. Trump that provides an excellent solution to the problems caused by Obamacare. Senator Paul argues that President Trump’s first term Executive Order creating Association Health Plans, allowing individuals to purchase insurance via large companies, like Costco, Amazon, and Sam’s Club, was a great idea. It was stopped by Democratic Attorneys General who used the courts to block it. Congress could pass this plan and avoid legal challenges.
The senator’s plan is titled the “Health Marketplace and Savings Accounts For All Act.” He describes his plan in an op-ed published in Newsweek on December 2, 2025, as a way to legalize “the ability for any group to purchase insurance collectively and operate across state lines.” Large companies would be legally allowed to band together to use the power of the millions of members of the plan to negotiate lower prices. He argues that “once these co-ops are legalized, the individual market likely melts away, and everyone in America would gain the benefits that normally accrue to the group market.” This is one element of his plan that would drive costs down.
A second plank of Sen. Paul’s plan would “allow everyone in America to have a Health Savings Account (HSA).” He points out that only 10 percent of insurance plans today are eligible for these tax-free accounts that cover many things that are not covered by traditional health insurance. The plan allows HSAs to be used to pay health insurance premiums. This makes sense because the biggest expenditure for healthcare consumers is premiums. The great benefit is that there will be no taxpayer money used in these plans.
There are competing ideas to reform the enhanced Obamacare subsidies that were put in place in the wake of the COVID panic. These subsidies are scheduled to expire soon, so Congress has to pass either an extension of the enhanced subsidies, a reformed version of these enhanced subsidies, or a free-market alternative that will stem the flood of taxpayer cash that is making our healthcare system less responsive to those in need.
It is a good idea to use market forces, instead of flooding insurance companies with taxpayer money, to get prices down for healthcare consumers. Republicans have promised for years to “repeal and replace” Obamacare, and now there is an idea that will get our healthcare system a bit closer to a free-market system that will benefit all.
Brian Darling is former Counsel and Sr. Communications Director for Sen. Rand Paul (R-KY).