Republicans scrambling for plan to fix healthcare, DC insider says

The bottom-line answer to America’s healthcare conundrum? “You want the most affordable way to do healthcare in our country? It’s universal healthcare, right?” said Jeff Bush of The Washington Update.

“That's the cheapest way to do it if you really want to go cheap," he said, "But certainly, the Republicans are not anywhere near universal healthcare. They're going the opposite way.”

A noted speaker and author and 30+-year veteran of the financial services industry, Bush delivered the keynote address Friday morning at the American Academy of Actuaries’ Academy Leadership Summit & Governance Transition.

Founded by Andy Friedman in 2008 and now headed by Bush, The Washington Update provides nonpartisan analysis on the Beltway political scene.

Democrats are making headway, another tax bill could be on the way, and Social Security will be fixed, Bush said. But first comes healthcare.

Republicans likely want to have a healthcare plan to present to Americans by the State of the Union address in late January, Bush said. The party most favors some type of “super HSA” where Americans negotiate and pay for service, he added.

“It's mind blowing to me that the Republicans can rationalize that the average American … is going to engage in a thoughtful negotiation with their cardiac surgeon,” Bush said. “Unfortunately, there's no good healthcare solution.”

While Republicans reiterated this week that the enhanced tax credits for the Affordable Care Act – the issue that shut down the federal government for 43 days – are a no-go, Bush isn’t buying it. Legislation dies and comes back to life 10 times before it passes, he noted.

“I think they’re going to have to extend them,” Bush said of the ACA subsidies.

Another tax bill?

The signature priority of the Trump administration – the One Big Beautiful Bill Act – was signed on July 4. It extended the tax cuts from Trump’s first term and added a few more.

But there are a few loose ends that will likely require Congress to produce another tax bill before the end of the year, or early in 2026, Bush said. In addition to the enhanced premium tax credits, Congress has a number of other lingering tax issues to deal with, he explained, such as the treatment of gambling losses

“There's also some interest around Secure Act 3.0, so we are seeing some conversations there,” Bush said. “I can't tell you the context of that yet. It’s still is not even spaghetti against a wall at this point. It's just the idea that they would like to talk about Secure Act 3.0 at some point.”

The SECURE Act, passed in 2019, aimed to expand access to workplace retirement plans, raise the age for required minimum distributions, and encourage small businesses to offer savings options. Building on that framework, Congress enacted SECURE 2.0 in 2022, a wide-ranging package that further raised the RMD age, boosted catch-up contributions, and introduced automatic enrollment for many new retirement plans.

The economy continues to go through a precarious period, with markets and costs affected by the Trump administration's tariffs. All of it will be felt in Washington when the 2026 elections roll around, Bush said.

“First of all, it is a referendum on Donald Trump's economy,” he said. “That's what it's going to be. But it's going to be viewed through this lens of affordability, and I think even more specifically, health care.”

Bush predicted that Democrats will win back control of the House of Representatives, but the Republicans will retain the Senate. That result will give Democrats just enough power to continually disrupt the last two years of Trump’s term, he said.

“I tell audiences all the time, ‘If you want to really understand how Washington, D.C. works, try to put yourself mentally in a very wealthy community in junior high,’” Bush quipped. “That's what Washington, D.C. is.”

Social Security will get fixed

One issue that isn’t worth much stress is the future of Social Security, Bush said. The trust fund behind many Americans' monthly Social Security benefits could be depleted in the next decade, leading to cuts in benefits of up to 23%.

Congress will have to address this funding shortfall via either a cut in benefits, raising the retirement age or increasing Social Security taxes. Or some combination of the three. But lawmakers will not act until the pain flips, Bush said.

“Right now, the pain of fixing Social Security is more than the pain of not fixing it,” he explained. “But as we approach that date, we'll see that transition where it will become more painful not to fix it than to fix it, and that's when they'll finally get serious about it.”

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InsuranceNewsNet Senior Editor John Hilton has covered business and other beats in more than 20 years of daily journalism. John may be reached at john.hilton@innfeedback.com. Follow him on Twitter @INNJohnH.