Top healthcare executive John Driscoll calls the looming expiration of enhanced Affordable Care Act subsidies “a tragedy in the making,” warning that millions of Americans are about to be hit with higher premiums, lost coverage, and rising medical debt as Washington gridlock hardens.
Driscoll, who is currently the chairman of UConn Health after a 25-year career in health care including a previous position as Walgreens Boots Alliance president, said the policy reversal amounts to “a self‑inflicted wound” that will push costs up for both low‑income families and the affluent professionals who thought they were insulated.
Driscoll cited CBO estimates that if Congress allows the subsidies to lapse, premiums will jump for roughly 24 million marketplace enrollees, and around 2 million people will lose coverage entirely in the near term.
Enhanced premium tax credits, introduced during the pandemic and extended through 2025, have helped double marketplace enrollment and kept average subsidized premiums under about $900 a year. When they expire, KFF News projects a roughly 114% increase in average premium payments for subsidized enrollees in 2026. Older adults and rural residents would be especially exposed, with KFF also warning that adults ages 50 to 64 could see average premium hikes of 75% or more.
The invisible tax on everyone else
Driscoll argued that the real story is a giant cost shift from government to households and employers, driven by simultaneous Medicaid cuts, work requirements, and subsidy rollbacks. When people lose coverage, he notes, they “don’t stop getting covered by the health care system.” Instead, they show up later and sicker, so hospitals and insurers respond by raising prices to anticipate uncompensated care.
When you consider that this is being done to “effectively subsidize a tax deduction for millionaires and billionaires, that’s going to shift health care costs to all of us when people lose coverage,” he added, referring to the One Big Beautiful Bill Act that extended President Donald Trump’s previous tax cuts and introduced new ones.
For Driscoll, the subsidy cliff exposes a deeper “tribal dysfunction” in health policy that has frozen the Affordable Care Act in place instead of improving it. He called Obamacare “a very good but imperfect solution” that cut the uninsured rate roughly in half and slowed healthcare inflation, but he said both parties have refused to engage in the hard work of updating it. “We really aren’t prioritizing the patient,” he said, “we’re prioritizing the politics,” leaving millions facing the choice of dropping coverage or postponing care for serious conditions.
The political situation
He had a warning for Republicans, calling this looming mass expiration of health insurance subsidies a “self-inflicted wound” for the party. “They were elected on solving affordability,” he pointed out, and now they’re going to accelerate the problem. But Driscoll said no side is blameless. “The tragic thing is, neither side really wants to have a sensible conversation about how do you really care for more people and get them better care earlier.”
It’s true that Democrats drove the ACA, but Driscoll said that by and large they are committed to defending something that was itself a compromise, and the other side is playing offense. “The danger is that some Democrats don’t want to have a conversation on evolving [the ACA] because they feel like they have to defend it and the Republicans don’t ever don’t want to have a conversation about evolving it because they want to destroy it.” The result is you end up here, in “this sort of ridiculous no progress zone.” (Driscoll did disclose that he is serving as Connecticut Governor Ned Lamont’s special advisor on health care.)
From his vantage point now, Driscoll argued that the reason America is bedevilled with constant healthcare issues is a mismatch of incentives. “Healthcare is a team sport that keeps getting undermined by individual incentives,” he said, noting that U.S. costs are twice as expensive as the average industrialized country and not nearly as productive, he pointed out.
In similar countries, roughly 50%-60% of doctors are primary care, but it’s only one in four in the U.S. The problem is that every doctor wants to be a specialist or a surgeon because they’ll roughly double the salary of a pediatrician or internist that way. “Until you change those incentives people are going to keep going towards those higher compensated areas.”
There’s no one fix to this, but there are steps we could take, Driscoll said. He pointed to expanded drug‑price negotiation, immigration reforms to ease shortages of primary‑care doctors and nurses, “site‑neutral” payment so patients aren’t charged more for identical hospital‑based care, and broader use of value‑based and bundled payment models. But we don’t even seem to be capable of engagement, he argued.
“If the two sides could talk,” Driscoll said, “there probably is a way that they could agree on how to to bridge the difference between what Biden and Trump want to do on drug costs. If we could talk, we could probably agree on how to bring back value-based care that would balance the interests of doctors and hospitals and and patients’ outcomes and the government’s obligation.” If only.
