Sue Dinsdale is the Executive Director of Iowa Citizen Action Network and the State Lead for Health Care for America NOW.

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 Affordable Care Act was passed fifteen years ago and has been fully in effect for more than a decade. 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. Failure to extend the credits could cause 4 million people to drop their health insurance, while millions more would pay double, triple, or more to keep their coverage. 

This year, about 24 million people are enrolled in ACA marketplaces, including nearly 137,000 Iowa Iowans. More than 90 percent of those who buy health insurance through an ACA marketplace 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 Democrats in Congress and President Barack Obama enacted the ACA, Republicans have tried many times to repeal the law and roll back Medicaid expansion. In his first term, President Donald Trump tried to end the ACA, arguing that it had to be replaced because the law was ineffective. But Republicans could not come up with a replacement or take on the insurance industry to force them to lower prices. 

Republicans seem willing to take health care away from millions of people in order to stick it to Obamacare even though there are more people in red states enrolled in the ACA than in blue states.

A Democratic bill, which would extend the credits for three years, would be a step toward permanent relief. Iowans need the stability and assurance of a full three years of tax credits to afford their health insurance. At this writing, 214 House members have signed a discharge petition that would force a floor vote. With only four more signatures needed on the discharge petition, Iowa’s delegation could make the difference by joining members across the aisle and supporting a bipartisan effort to deliver affordable health care for everyday Iowans.

Instead, Representative Zach Nunn, who is facing a tough reelection bid in Iowa’s third district, cosponsored a bill called the “Fix It Act” (that has only nine co-sponsors and appears likely to fail in Congress). Representative Mariannette Miller-Meeks, another vulnerable incumbent in Iowa’s first district, has said she supports lowering health care costs but the ACA enhanced premium tax credits are not the best way to address rising costs.

Representative Ashley Hinson (IA-02) said through a spokesperson that she backs efforts to address health care inflation but is more supportive of ideas on shifting funding to a Health Savings Accounts. And Representative Randy Feenstra (IA-04) 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 health care are decidedly unpopular. The budget reconciliation bill that Republicans enacted in July included nearly $1 trillion in Medicaid cuts, which 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 that same law 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 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 health care. Their revived fixation on Health Savings Accounts is an example. These accounts are not insurance and generally don’t provide enough funds to help people buy insurance that will cover all their health care needs, ensure access or protect them from debt. They can’t be used to pay for premiums so it won’t help most people afford their current coverage.

In addition, Health Savings Accounts require individuals to be enrolled in high-deductible plans with skimpy coverage that on average cost much more than the $1,000 to $1,500 that some Republicans are proposing as an alternative to health insurance premium tax credits. 

Lawmakers in Congress and Trump need to focus on the basic solution to affordability that is already in place: renew the ACA premium tax credits before the Christmas holiday.