Top healthcare executive John Driscoll has called the looming expiration of enhanced Affordable Care Act subsidies “a tragedy in the making,” warning that millions of Americans will face higher premiums, lost coverage, and mounting medical debt as Washington gridlock tightens.
Driscoll, who is currently president of UConn Health after a 25-year career in health care, including a previous position as president of the Walgreens Boot Alliance, said reversing the policy would be a “self-inflicted wound” that would raise costs for both low-income families and the wealthy professionals who insulated them.
Driscoll cited CBO estimates that if Congress allows the subsidies to end, premiums would jump for about 24 million Marketplace enrollees, and About 20 million people will lose coverage completely in the near term.
“You don’t solve higher health care costs by insuring fewer people,” he said fateArguing that the system would reassess risk and shift costs to everyone else. “When you reduce coverage at the bottom, everyone pays more in the middle.”
Enhanced premium tax credits, introduced during the pandemic and extended through 2025, have helped double enrollment in the market and kept average subsidized premiums below $900 a year. When they expire, KFF News projects a nearly 114% increase in average premium payments for subsidized enrollees in 2026. Older adults and rural residents will be particularly exposed, with KFF also warning that adults aged 50 to 64 could see average premium increases of 75% or more.
Make everyone invisible
Driscoll argued that the real story is a massive cost shift from the government to households and employers, simultaneously driven by Medicaid cuts, work requirements, and subsidy rollbacks. When people lose coverage, he notes, they “don’t stop being covered by the health care system.” Instead, they show up later and get sicker, so hospitals and insurers respond by raising prices for uncompensated care.
When you consider that “to effectively subsidize tax cuts for millionaires and billionaires, it’s going to change the health care costs of all of us when people lose coverage,” he added, referring to President Donald Trump’s One Big Beautiful bill, which extended previous tax cuts.
For Driscoll, the subsidy cliff exposes a deep “tribal dysfunction” in health policy that has frozen the Affordable Care Act instead of reforming it. He called Obamacare “a very good but incomplete solution” that nearly cut uninsured rates in half and reduced health care inflation, but he said both parties have refused to engage in the hard work of updating it. “We’re not really prioritizing the patient,” he said.
political situation
He had a warning for Republicans, calling the collective expiration of health insurance subsidies a “suicide wound” for the party. “They were elected on affordable solutions,” he pointed out, and now they’re going to accelerate the problem. But Driscoll said no side is blameless. “The sad thing is, neither side really wants to have a sensible conversation about how to take care of more people and take better care of them already.”
It’s true that Democrats ran the ACA, but Driscoll said they’re committed to protecting what they agreed to, and the other side is playing offense. “The danger is that some Democrats don’t want to talk about growth [the ACA] Because they feel like they have to protect it and the Republicans don’t want to talk about developing it because they want to destroy it.” The result ends up being, “This is kind of ridiculous in any progress field.” (Driscoll revealed that he is serving as a special adviser on health care to Connecticut Governor Ned Lamont.)
From his vantage point in the present, Driscoll argued that the reason America is constantly beset by health care issues is a mismatch of incentives. “Health care is a team sport that is undermined by individual incentives,” he said, noting that the U.S. costs twice as much as the average industrialized country and is not nearly as productive, he said.
In similar countries, about 50%-60% of doctors are primary care, but only one in four in the US. The problem is that every doctor wants to become a specialist or surgeon because they will make almost double the salary of a pediatrician or internist. “Unless you change those incentives, people are going to move into those high-compensation areas.”
There’s no one fix, but there are steps we can take, Driscoll said. He pointed to expanded drug-price negotiations, immigration reforms to ease the shortage of primary care doctors and nurses, “site-neutral” payment so patients don’t pay more for the same hospital-based care, and widespread use of value-based and bundled payment models. But we are not even capable of engagement, he argued.
Driscoll said, “If the two sides could talk, there might be a way they could agree on how to bridge the gap between what Biden and Trump want to do on drug prices. If we could talk, we could agree on how to bring back value-based care that balances the interests of outcomes and government liability for doctors and hospitals and patients.” If only.
This story was originally featured on Fortune.com
