Word from Capitol Hill is that Republicans intend to tiptoe around health care this cycle—as if ignoring the issue might spare us midterm misstep. Some strategists at least suggest token reforms and then calling it a day. But treating health care as an unwelcome guest to be endured isn’t strategy; it’s political suicide.
Health care is not a losing issue because it is unwinnable. It’s losing because Republicans don’t know how to talk about it. Their reluctance to take on the issue has been palpable, and when they do, they typically frame it in terms of jobs and the economy, allowing Democrats to claim a monopoly on empathy. While the Left talks about people hurt by being unable to afford medical coverage, the GOP talks about impersonal government expenditures. Democrats frame themselves as caring about people; the GOP sounds like they care only about money.
The results? Predictable.
The GOP can be head-in-the-sand ostriches, but Democrats will run on health care in the midterms. Unless Republicans mishandle abortion messaging, the issue of health care is the only strong card Democrats have Left. And expect Democrats to play it relentlessly, because health care is the core of the affordability crisis Americans actually feel. Grocery and gas prices may sting, but medical and housing costs are what flatten family budgets. When Republicans fail to speak to this, they’re not just letting an issue slip away—they are forfeiting the economic argument itself.
Worse still, if Republicans have had a governing trifecta and do nothing meaningful on health care, the political damage will be self-inflicted and lasting. The GOP will be cast as guardians of a dysfunctional status quo—protecting a failed Affordable Care Act (ACA) and its true beneficiaries—insurers, drug middlemen, and hospital conglomerates—while families pay more for less.
Fair or not, inaction reads as approbation and silence reads as indifference.
The good news? Republicans don’t need a thousand-page plan. They already have a coherent, pro-consumer agenda grounded in reforms that expand freedom, lower costs, and empower individuals rather than bureaucracies. Three pillars are already written into bills with strong conservative pedigrees, pillars that every GOP candidate should memorize and GOP leadership should work to get enacted ASAP: personal medical wallets, portable insurance, and comprehensive price transparency.
1. Personal medical wallets.
Forget the jargon of “HSAs.” What matters is control. The Health Care Freedom for Patients Act by Sens. Mike Crapo and Bill Cassidy expands tax-advantaged accounts and pre-funds them for families, allowing Americans to pay directly for care instead of begging insurers for permission. This is the difference between being a supplicant in a broken system and being a consumer with leverage. It lowers costs by shifting power from insurers to patients. This could and should be expanded to ALL patients.
2. Real price transparency—finally.
For all the political theater, the largest source of waste and frustration in health care is opaque pricing. Only a small slice of healthcare spending is on retail drugs. The vast majority is in shoppable services—MRIs, planned surgeries, tests—where prices vary wildly and are often hidden by design. The bipartisan Patients Deserve Price Tags Act, from Sens. Roger Marshall and John Hickenlooper, would finally implement and enforce the transparency rules that Americans were promised years ago and still have not received. Transparency is not symbolic; it is catalytic. When prices are public and comparable, competition forces costs down. Without transparency, portability and personal wallets cannot function. With it, the market finally behaves like a market.
3. Portable benefits that follow the worker.
In a modern, mobile workforce, tying your insurance to your employer should be obsolete. Sen. Rick Scott’s More Affordable Care Act takes an important step in that direction by giving states the option to support cross-state coverage options, meaning you can join a plan near your new home in advance of an anticipated move or, if you are staying put, you can shop for a plan in a state with lower rates. It also takes government funding that goes to insurance companies to support ACA premiums and uses those dollars to fund individual health accounts. More should be done to encourage portability–most importantly directing tax subsidies away from insurers and toward individuals, which is the first step toward making all ACA-compliant plans, including most employer coverage, portable. Ultimately, the law should be changed so that employees leaving a job can take their insurance coverage with them, and individuals should be allowed to use pretax dollars to pay those premiums. This bill is an important first step toward this principle: your healthcare security should be yours, wherever you go—not something that disappears if you move or change jobs.
As Dr. Monique Yohanan argues, transparency and portability reinforce one another. Information without the freedom to act is useless; freedom without information is blind. Paired with personal medical wallets, right there on your phone, just like an Apple Wallet - the system becomes one where patients—not special interests—set the terms.
Republicans should move these bills now, before political oxygen is consumed by campaign noise. Advancing them in a divided Congress forces Democrats into an uncomfortable choice: oppose reforms that clearly help families—or support them and share credit. If Democrats block these bills, Republicans enter the midterms with a clear understandable position on health care that will resonate with voters, and place Democrats as the wardens of the dysfunctional status quo. If the reforms pass, Americans feel relief in their actual medical bills. Either path strengthens the GOP’s standing.
The biggest mistake Republicans can make is believing health care is best avoided. The opposite is true. Voters do not expect perfection, but they demand seriousness—and they can tell when a party refuses to engage on the issue that most threatens their economic security.
Health care isn’t just another line item; it’s the skeleton key to affordability. Whoever speaks credibly to that pain point wins the trust of the middle. Whoever ignores it forfeits the narrative—and the election.
This moment offers Republicans a rare alignment of good policy and good politics. Speak clearly, act boldly, and reclaim medical care as a conservative strength.
Heather R. Higgins is CEO of Independent Women’s Voice.
