Health insurance veteran Mike Smith says ACA gains at risk as subsidies expire and costs climb

In a wide-ranging discussion on the Health Policy Podcast, Mike Smith, President Emeritus at The Brokerage Inc., outlines how the Affordable Care Act expanded coverage to millions of previously uninsured Americans but failed to deliver on long-term affordability. Smith explains that while subsidies helped drive enrollment and improve access to care, rising base premiums and the expiration of enhanced tax credits in late 2025 have led many consumers to drop coverage. He describes a market now marked by instability, limited private-sector solutions, and growing reliance on government funding, warning that current trends could push the U.S. closer to a national healthcare system if sustainable reforms are not found