So here’s how my new year started: my insurance premium jumped from $259 to $412. That’s a 59% increase. In one year.

I’m not alone. Over 24 million Americans just lost their Obamacare subsidies on January 1st, and now about 90% of people buying insurance through the exchanges are dealing with the same sticker shock. You either pay up or go without coverage. Those are your options.

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The wild thing? Congress knew this was coming. This exact fight about extending subsidies literally caused the longest government shutdown in American history just a few months ago. Democrats wanted to keep the subsidies, Republicans refused, Republicans won. Democrats tried one last time in December to save them. Nope—kicked down the road again.

And now? Same circus, different month. On January 8th, the House passed a bill 230-196 to bring the subsidies back for three years. Seventeen Republicans broke ranks because they’re terrified health care is going to cost them their seats in 2026. The bill would cost $80 billion, cover 4 million more people, and lower costs for millions more. Senate Republicans have already declared it dead on arrival.

Let me put this in perspective: Americans spent $13,432 per person on health care in 2023. That’s over $3,700 more than any other wealthy country. Other developed nations averaged $7,393—literally half what we pay. We’re spending nearly 17% of our entire economy on health care, while other countries cover everyone for way less.

So why can’t Congress fix this?

According to research from the University of Virginia, it comes down to two problems: a hopelessly complicated system and Congress members who won’t do the hard work of fixing it.

First, our health care system is incredibly complicated. Here’s how it actually works: the federal government provides tax credits and subsidies to help people purchase health insurance from private companies operating through marketplaces across all 50 states. But here’s where it gets messy—19 states run their own insurance exchanges while the rest use the federal system. And each state that runs its own exchange gets to set different standards, approve different plans, and impose their own additional requirements. Some states have their own individual mandates, others don’t. Some offer state-funded subsidies on top of federal ones, others don’t. You’ve basically got 50 different versions of the same system, all regulated differently.

And honestly? That’s ridiculous. States shouldn’t be making these decisions in the first place. We need a nationwide health care system where everyone gets the same basic rights, no matter what zip code they live in. Sure, if people want to pay extra for premium services, fine—but the baseline should be the same for everyone. Your access to affordable health care shouldn’t depend on whether your state government decided to be generous or not.

Second, most members of Congress just don’t want to deal with it. They let party leadership handle the complicated stuff. Nobody wants to do the hard work of negotiating across the aisle and then explaining messy compromises to voters. So instead, we get tiny changes designed to score political points. And as the parties drift further apart on basic questions—should government help or should people figure it out themselves—working together becomes basically impossible.

Some senators claim they’re working on a bipartisan compromise. Senator Susan Collins says they’re trying to put together a bill with reforms plus a two-year extension, and Senator Jeanne Shaheen says negotiations are continuing. But Senator Eric Schmitt already said he doesn’t think they can get the 60 votes needed. They’re still stuck fighting about abortion restrictions and income caps. And plenty of Republicans just oppose the subsidies entirely.

And Schmitt was right. On January 14th, the Senate blocked the House bill—it didn’t even meet the 60-vote threshold to get a floor vote. So millions of us are still stuck with these massive premium increases while senators keep talking about a bipartisan compromise that may never materialize.

Here’s what really gets me: health care is a human right. People literally die without it. Other countries figured this out decades ago. But we’re stuck negotiating with insurance companies whose entire business model is to maximize profit, not to keep people healthy. They don’t care if you can afford your medication or see a doctor. They care about their bottom line.

Here’s a simple solution: Congress should pass the Democrats’ proposal to extend the subsidies for at least a year, or the three years they’re suggesting. That buys time. Then work on an actual bipartisan fix that makes health care better for everyone.

Or we could just do what actually works: Medicare for All. 94% of Medicare beneficiaries are satisfied with their coverage, and they have fewer cost problems than people with private insurance. Medicare works for seniors and people with low incomes. Why not extend it to everyone? We already know the model works.

Every politician campaigns on fixing health care costs. But we’ve been having this exact same fight since the early 1900s. Over a century of the same arguments, the same problems, the same failures.

Right now millions of us are watching our premiums explode. The solution is right in front of us—we just need Congress to have the courage to do it.