Last week, the Senate Homeland Security and Governmental Affairs’ Subcommittee on Investigations held a hearing “Assessing the Damage Done by Obamacare.” The witnesses included several leaders from right-leaning health policy think-tanks such as the Paragon Institute and the Foundation for Government Accountability, as well as an Affordable Care Act (ACA) Marketplace enrollee. Lawmakers questioned witnesses about the law’s impact on premiums, access to care and the sustainability of federal subsidies.   

Subcommittee Chair Senator Ron Johnson (R-WI) opened the hearing by criticizing the ACA’s design, arguing that it drove up costs and restricted choice. He pointed to premium increases and limited network options in several states as evidence that the law has failed to deliver affordable coverage. Sen. Johnson called for “real reform” that returns decision-making power to individuals and states rather than what he described as “federal micromanagement of health care.” 

Democratic senators pushed back, defending the ACA’s role in expanding insurance coverage to millions of Americans. They warned that rolling back federal subsidies or weakening consumer protections could trigger sharp coverage losses. Senator Richard Blumenthal (D-CT) emphasized that the ACA “has saved lives and strengthened families” and that any major repeal effort would “throw the health system into chaos.” 

Witnesses offered contrasting perspectives. One enrollee described how rising deductibles and limited provider networks made her ACA plan “feel like having insurance but not access.” A policy expert from the Paragon Health Institute testified that the ACA “cemented a costly, top-down model” that increased federal spending without addressing underlying price inflation. In contrast, a health-policy analyst invited by Democrats cited evidence that Marketplace premiums stabilized after 2019 and that recent subsidy expansions sharply reduced the uninsured rate. 

The discussion also focused on the looming expiration of enhanced ACA subsidies enacted during the pandemic. Without congressional action, nearly 22 million enrollees could face higher premiums in 2026. Lawmakers on both sides acknowledged the urgency of finding a solution, though deep divisions remain over whether to extend or restructure the credits. 

As the hearing closed, senators agreed on one point: the coming year will shape the next phase of American health policy. Whether Congress strengthens, reforms or replaces the ACA, the debate over access, affordability and government’s role in health care shows no sign of ending.