Republicans actually do have a healthcare plan, and it’s a good one

Skip to content

The views expressed by contributors are their own and not the view of The Hill

As the midterms approach, Americans have made affordability its top concern. And nowhere is this concern more urgent than in healthcare.

Voters have good reason to be worried. In 2024, U.S. health spending rose 7.2 percent to $5.3 trillion — an astonishing $15,474 per person.

Democrats often claim that Republicans don’t have a plan to help people struggling with uninsurance and high health care bills. The latest version of the Fair Care Act, introduced recently by Rep. Bruce Westerman (R-Ark.), rebuts this assertion, and it incorporates longstanding bipartisan priorities to boot.

First introduced in 2018, the Fair Care Act moves American health care in the right direction by achieving four broad goals.

First, it achieves universal, and universally affordable, coverage for Americans today, while creating a more fiscally sustainable system for generations to come. For example, the bill would strengthen the individual market by restoring the age rating system that existed before the Affordable Care Act — a reform designed to lower insurance premiums for younger enrollees. And in addition to codifying the Affordable Care Act’s pre-existing condition protections, the Fair Care Act creates invisible high risk pools to directly fund high-cost enrollees, thus reducing premiums for healthier enrollees.

Second, the Fair Care Act gives all Americans freedom to choose among a variety of insurance plans that fits their needs. Instead of forcing workers into plans chosen by their employers or government officials, it gives consumers more power to select coverage that best fits their needs. The Foundation for Research on Equal Opportunity estimates that this would give more than 100 million Americans more choices.

Third, the Fair Care Act promotes fairness to taxpayers by focusing assistance on those with the greatest need, including lower-income families, individuals with serious health conditions, and other vulnerable populations.

The bill creates a market-based alternative to the Affordable Care Act’s Medicaid expansion by extending premium subsidies to those below the poverty line. It expands eligibility to households earning between 400 and 600 percent of the poverty line, but since premiums vary by age, older Americans — who tend to be wealthier — could pay a larger portion of the premium than they would under the previous pandemic-era enhanced subsidies that lacked age variability. These coverage improvements would be financed through savings elsewhere in the bill, including reforms that better adjust Medicare subsidies for high-net worth seniors.

Finally, the bill expands competition and curtails the power of health care monopolies, lowering patients’ costs and increasing innovation in patient care.

To address this problem, the Fair Care Act targets hospital consolidation that allows dominant systems to exert pricing power over patients. Rather than solely relying on increased regulatory enforcement to prevent future hospital mergers, the bill provides a novel mechanism for hospital systems to self-enforce antitrust policies by giving consolidated systems one of two options: Either a consolidated system can charge whatever price it wants, so long as it voluntarily divests hospitals to bring true competition to the local market; or, if the system chooses to remain consolidated, it must accept lower prices that gradually reduce to median rates paid by Medicare Advantage plans.

The bill also eliminates payment loopholes that encourage hospitals to acquire physician practices to control larger segments of the health care supply chain, while also providing incentives for states to address anti-competitive behavior from providers.

On prescription drugs, the legislation would crack down on abuses of the patent and regulatory systems that allow monopolies to last longer than intended. At the same time, it creates a more efficient approval pathway for promising therapies, reducing research and development costs and, in turn, the financial risk associated with bringing innovative drugs to market.

There are many more bipartisan solutions in the Fair Care Act, from malpractice reform to permanent telehealth expansion. Taken together, the Fair Care Act is designed to increase the number of insured Americans while maintaining fiscal discipline—strengthening, rather than straining, programs like Medicare and Medicaid.

The U.S. delivers world-class treatments and cutting-edge therapies, yet leaves Americans sicker and living shorter lives than many industrialized countries. On treatable mortality—deaths that are amenable to timely and effective care — the U.S. exceeds 109 deaths  per 100,000 people, two-and-a-half times Switzerland’s rate of 43.

In short, we pay more for a system that delivers less. We can and must do better.

That is where the Fair Care Act of 2026 comes in. As the midterms approach, Republicans have an opportunity to tell a different story than the one Americans have believed about them for years: that they care about health care affordability and are willing to do something about it.

Voters will reward them for it — and, most importantly, they will be doing the country a great service.

Gregg Girvan is the resident fellow for health care policy at the Foundation for Research on Equal Opportunity.

Tags

Bruce Westerman

Copyright 2026 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.