The midterms are approaching fast, and polls paint a grim picture for Republicans. GOP candidates are struggling to win over voters concerned about healthcare costs.
Since President Trump returned to office, congressional Republicans have enacted several significant healthcare reforms. Some aim to restrain government spending. Others could put more money in patients' pockets, expand their control over healthcare expenses, or address practices that contribute to high prices.
Consider the Medicaid reforms included in last year's Working Families Tax Cut legislation.
Medicaid spending more than doubled between 2010 and 2024, rising from $397 billion to $932 billion. The new law seeks to restrain that growth, in part by requiring certain working-age beneficiaries to work, volunteer, or participate in education or job training for at least 80 hours per month to maintain their coverage. The requirements generally take effect in January 2027.
The Congressional Budget Office estimates that the requirements will reduce federal Medicaid spending by more than $325 billion over 10 years.
Those are real savings for current and future taxpayers.
Another provision in the 2025 law cracks down on the use of "provider taxes" to obtain additional federal funding.
Medicaid's funding formula rewards states with at least one federal dollar for each dollar they spend on the program. Some states exploit that arrangement by taxing hospitals, returning the revenue through higher Medicaid payments, and claiming additional federal matching funds.
Hospitals can receive more than they paid in taxes, while states shift much of the cost of their programs onto federal taxpayers.
Provider taxes also drive up health insurance premiums. An October 20 study from the Department of Health and Human Services, coauthored by economist Casey Mulligan, estimates that hospital provider taxes have increased premiums for employer-sponsored health insurance by 1.5 percent to 1.7 percent.
The 2025 law restricts new or increased provider taxes and gradually lowers permitted rates in Medicaid expansion states.
Mulligan and his colleagues project that these changes could reduce employer-sponsored premiums by 2.2 percent to 2.5 percent by 2032, compared with what they otherwise would have been. They further estimate that lower employer insurance costs could translate into an additional $640 to $730 in annual wages for the average household with employer-sponsored coverage.
Republicans have expanded access to health savings accounts, too.
Beginning this year, people with qualifying Bronze-level Obamacare or catastrophic plans became eligible to contribute to HSAs.
HSAs let people save tax-free for medical expenses, reducing their tax bills today. Unspent balances roll over indefinitely, can grow tax-free through investments, and remain available for qualified medical expenses decades later.
Patients also control their HSA dollars. They can compare prices, choose providers, and keep the savings when they find better-value care.
The White House estimated that Republicans' changes to HSAs made approximately 7.3 million additional Americans eligible to contribute.
In addition, the Trump administration is promoting CHOICE Arrangements, which allow employers to provide tax-free funds for workers to purchase their own health insurance. Established during Trump's first term, these arrangements give employees more control over their coverage while offering businesses an alternative to traditional group plans.
The GOP has also taken aim at pharmacy benefit managers, or PBMs, the middlemen that negotiate drug prices and rebates on behalf of health plans.
Some PBMs profit by favoring medicines with larger rebates over cheaper alternatives. When their compensation depends on the size of the rebates they negotiate, higher drug prices can mean higher profits. Meanwhile, patients whose cost-sharing is based on inflated list prices can pay more at the pharmacy counter, even when their health plans receive substantial discounts.
In February, Congress enacted reforms requiring PBMs to pass manufacturer rebates and discounts through to covered employer health plans and disclose more information about their financial arrangements.
Six in ten voters say they're worried about being able to afford their healthcare costs. Over the past two years, Republicans have taken action to address those concerns. They've enacted reforms designed to rein in wasteful spending, put more healthcare dollars under patients' control, and tackle practices that drive up prices.
That's a record worth remembering as the midterms approach.
Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The World's Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It (Encounter 2025). Follow her on X @sallypipes.