Millions of Americans are struggling with the high cost of services and goods this holiday season, as politicians in Congress seem stuck in the past rather than looking out for our future. The ACA has been in place for 15 years now. Despite its proven track record and majority support for the law, here we are again.

There’s no better example than the current health care affordability crisis. It’s not new, but the fight is coming to a head as Republicans in Congress continue to refuse to extend the premium tax credits that millions of people depend on for Affordable Care Act marketplace coverage which could result in over 4 million people losing coverage and millions more paying double, triple or more to keep their coverage.

This year, about 24 million people are enrolled in ACA marketplaces, including nearly 137,000 in Iowa. Over 90% of enrollees use premium tax credits to help pay for coverage. Before the tax credits, only about half as many people could afford it. If Congress lets these tax credits expire, the number of people who can’t afford coverage will skyrocket.

The refrain is as familiar as an old Christmas carol. Since its passage, the GOP has tried to repeal the ACA and Medicaid expansion. In his first term President Trump tried to end the ACA, arguing that it had to be replaced because the law was ineffective. But they could not come up with a replacement or take on the insurance industry and force them to lower prices.

Republicans seem willing to take healthcare away from millions of people in order to stick it to Obamacare even though there are more people in Republican states enrolled in the ACA than Democratic controlled ones.

A discharge petition, supported by 214 lawmakers, would extend the credits for three years, a step toward permanent relief. Iowans need the stability and assurance of a full three years of tax credits to afford their health insurance. With only four more signatures needed on the discharge petition Iowa Members of Congress could make the difference by joining members across the aisle and supporting a bipartisan effort to deliver affordable health care for everyday Iowans.

Instead, Rep. Nunn, who is facing a tough reelection bid, cosponsored a bill called the “Fix It Act” (that has only nine co-sponsors and appears likely to fail in Congress). Rep. Miller-Meeks, who is also predicted to have a close race in the 2026 election season, said she supports lowering health care costs but the ACA enhanced premium tax credits are not the best way to address rising costs. Rep. Hinson’s spokesperson said she backs efforts to address health care inflation but is more supportive of ideas on shifting funding to Health Savings Accounts. And Rep. Feenstra says he supports lowering health care premiums but hasn’t backed any specific proposals that could come before Congress.

As in the past, cuts to healthcare are decidedly unpopular. The nearly 1 trillion in cuts to Medicaid that the GOP passed in their One Big Beautiful Bill Act (OBBBA) were among the most unpopular provisions in the bill. The billions in tax breaks that Republicans gave away to wealthy people and big insurance and prescription drug corporations under OBBBA are also hugely unpopular. The corporations they rewarded with big tax loopholes have turned right around and raised premiums not just for ACA coverage, but also hiked premiums in Employer Sponsored Coverage (ESC) and for Medicare Part B coverage.

Trump and the GOP are recycling policy ideas that make more money for Wall Street while leaving people with less healthcare. Their revived fixation on Health Savings Accounts (HSAs) is an example. HSAs are not insurance and generally don’t provide enough funds to help people buy insurance that will cover all their healthcare needs, ensure access or protect them from debt. HSA funds can’t be used to pay for premiums so it won’t help most people afford their current coverage. HSAs require individuals to be enrolled in high-deductible plans with skimpy coverage that on average cost much more than the $1000 – $1500 that some Republicans are proposing as an alternative to premium tax credits.

Lawmakers in Congress and President Trump need to focus on the basic solution to affordability that is already in place and keep it in place by renewing the ACA premium tax credits before the Christmas holiday.

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Sue Dinsdale is the executive director

of the Iowa Citizen Action Network.