As millions of Americans face pricier health insurance, is 'Trumpcare' the solution?

Health insurance could be about to get a lot more expensive for millions of Americans, and that's posing a political challenge for U.S. President Donald Trump.

That challenge comes from two conflicting fundamentals underpinning his presidency: his promise to make life more affordable for Americans and his determination to tear down any affordability measures established by the last two Democratic presidents, Joe Biden and Barack Obama.

That conflict hits its peak with the Affordable Care Act (ACA), the program colloquially known as Obamacare.

Enhanced tax credits introduced in 2021 under Biden, which brought down the cost of ACA premiums for roughly 24 million people, are due to expire on Dec. 31. The end of the credits — often described as subsidies — will result in the average premium more than doubling, according to an analysis by KFF, an independent health policy organization.

A family of four with a household income of $75,000, roughly in the middle of the U.S. annual earnings spectrum, would see annual premiums jump from $2,498 to $5,865, according to the analysis.

By some estimates, it's leaving millions of Americans facing the prospect of giving up their health insurance altogether.

Lori Hunt, a breast cancer survivor in Iowa recently laid off from her administrative job at a non-profit, faces a $650 US increase in her monthly payment to keep her existing policy.

"That's just about as much as my mortgage," Hunt said in an interview from her home in Des Moines. "Right now, that is not in my budget. That is not anything I can afford."

Hunt says her only options are to switch to a plan with less coverage or higher deductibles, or to go without health insurance until she finds a job that provides it.

"It's just a gamble and I hate it," she said. "I'd have to just kind of hope for the best."

The hope that remains for Hunt and others in her situation, albeit faint, is that the Republican-controlled Congress agrees to some kind of extension of the enhanced ACA subsidies.

The ACA was designed to cover the millions of people who don't have employer-paid health insurance, but don't qualify for Medicare because they're not seniors, or for Medicaid because they're not living in poverty. Typically, they're self-employed, underemployed, or retired before 65.

The fate of the subsidies was central to the Democrats' move to trigger this fall's record-long government shutdown. It ended when Senate Republicans agreed to hold a vote on extending the subsidies — a vote likely to take place next week, but with no guarantee of success.

Meanwhile, Trump is floating his own idea that he claims would tackle rising health-care premiums. His idea would also deal a crippling blow to Obamacare, a program he tried to eliminate from the start of his first term. That push failed when Republicans in Congress balked because the ACA was benefitting many of their voters.