The good news for health care advocates: The ACA is working; it's popular; and it's brought health security to a record number of Americans.

The bad news for health care advocates: There are some ominous, Republican-seeded clouds on the horizon.

Four years ago, President Joe Biden set out to lower the uninsured rate and bring health security to more Americans. As the Democrat prepares to leave office, there can be no doubt that he succeeded. The White House boasted in a written statement about the latest Affordable Care Act enrollment totals:

[As a result of White House efforts,] the Biden-Harris Administration is announcing that it has set another all-time record for ACA Marketplace enrollment, with nearly 24 million Americans signing up for coverage with one week left in the 2025 Open Enrollment Period. A total of 45 million Americans have coverage through the ACA — either the Marketplace or Medicaid expansion — and more people have health insurance today than ever in our nation’s history.”

The president and his team have every reason to boast, and it’d be a mistake to see the latest good news is some kind of accident. On the contrary, as Biden’s term got underway, Democrats included generous new ACA subsidies in their American Rescue Plan — the party’s Inflation Reduction Act kept the premium assistance in place — and their efforts made “Obamacare” more affordable than ever before. Consumers noticed, and enrollment totals soared.

The results for health care advocates are worth celebrating: The Affordable Care Act is working, it’s increasingly popular, and it’s brought health security to more Americans than at any time in history......

Complicating matters, the Democratic subsidies that have made ACA coverage more affordable are temporary — and they’re set to expire this year, creating what some observers have labeled a health care “time bomb.” Indeed, according to a recent Congressional Budget Office analysis, if the subsidies expire altogether, several million Americans will likely lose their coverage.

As the last Congress neared its end, several Democrats tried to extend the status quo for another year, but GOP lawmakers ignored the proposal before heading home in mid-December.

As for what’s likely to happen next, no one seems able to say for sure. A lobbying coalition is taking shape to push Republicans to keep premium costs low, but a variety of key GOP officials have already suggested they’re prepared to see some or all of the subsidies disappear.