There is a familiar dance in Washington, performed with wearying regularity whenever the complex machinery of American health care threatens to grind against political reality.
The music is playing once more, and two New Jersey congressmen, Jeff Van Drew and Tom Kean Jr., are attempting a particularly precarious step: talking earnestly about protecting working families from soaring insurance premiums just months after voting to rip health coverage from millions of those people.
This contradiction is not a minor flaw in logic.
It is the central story of a Republican Party and a Trump administration, whose draconian policy ambitions have crashed into the hard wall of public need, leaving them weakened and exposed.
Amid a government shutdown, as inflation pinches wallets, and as communities reel from the violence of a rampaged federal immigration force, the GOP’s long war on the Affordable Care Act has reached a moment of profound reckoning, like a dog that caught a car tire.
The arithmetic is stark.
Premiums for ACA plans in New Jersey are set to rise an average of 15.9 percent.
Some 454,000 state residents face sharp cost increases because enhanced federal subsidies are expiring. These subsidies, expanded during the pandemic, are supported by 78% of the public, including 57% of Republicans who identify with the MAGA movement.
In an Oct. 21 letter to House Speaker Mike Johnson, Van Drew and Kean pleaded for a “conservative path” to prevent the subsidies from lapsing despite clear signs that so-called conservatives never want them in the first place.
“Allowing these tax credits to lapse without a clear path forward would risk real harm to those we represent,” Van Drew and Kean wrote.
The letter was conspicuously vague, offering no plan, only concern.
This concern arrives with a staggering lack of self-awareness. Last summer, both men voted for the centerpiece of the second Trump administration’s domestic agenda: a reconciliation bill that the Congressional Budget Office estimates will remove roughly 10 million people from Medicaid.
In New Jersey, approximately 324,000 residents face the loss of NJ FamilyCare coverage.
That same bill delivers an average annual benefit of $13,600 to the wealthiest 10% of households, financed in part by stripping about $1,200 per year from the poorest 10%.
Van Drew, in a statement, attempts to square this circle.
“I have been very clear that I do not support the ACA as it exists today, but the families who rely on these credits did nothing wrong,” Van Drew said. The irony is thick enough to cut.
He now seeks to preserve a subsidy structure that is, itself, a Republican invention—the income-based framework pioneered by GOP thinkers in the 1990s and enacted by Mitt Romney in Massachusetts. Having voted to gut the law’s coverage foundation, he scrambles to apply a temporary bandage to a wound his party actively inflicted.
The political calculus is transparent.
Campaign experts see Kean as the only potentially vulnerable New Jersey Republican in 2026, though a Democratic wave could endanger Van Drew, the former Democrat turned staunch Trump ally.
Their letter is co-signed by other vulnerable members from Pennsylvania and California. This is emblematic of a political survival instinct, not a policy conviction.
Their predicament underscores a greater truth: the Republican health care project is bankrupt.
After more than 70 symbolic votes to repeal or gut the ACA over a decade, and one serious, failed attempt in 2017, the party has no coherent alternative. Ideas like health savings account vouchers, recently floated by some senators, are recycled concepts that risk destabilizing insurance pools and leaving the sickest behind.
The “conservative path” Van Drew and Kean invoke is a road to nowhere, a rhetorical fig leaf for a party that knows repeal is politically toxic but is ideologically incapable of endorsing the existing structure.
This internal fracture is paralyzing the GOP House majority.
Last week, leadership was forced to pull two labor-related bills from the floor, fearing defeat.
In a telling rebellion, Van Drew, New Jersey Rep. Chris Smith, and four other Republicans joined Democrats to sink a separate piece of legislation that would have allowed employers not to pay workers compelled to attend job-related training.
“People who got a certain amount in their paychecks would get less. I don’t agree with that,” Van Drew said, displaying a selective solidarity that vanishes when the paychecks of billionaires are on the line.
Johnson’s claim that “We’re totally in control of the House” rings hollow because cowards like Van Drew and Kean are wandering off the reservation at a time when the GOP has a tiny majority.
Unexpected vacancies have whittled the G.O.P.’s edge to just a couple of votes, leaving Johnson now able to afford just two defections on any party-line vote if all members are present — and in an election year, they seldom are. In the coming weeks, his situation is expected to become worse, whittling down the margin to a single vote.
His majority is set to shrink further after the upcoming special elections. Credit for recent GOP victories lies with Democrats, who abandoned the shutdown without getting Medicaid funding and an extension of the ACA credits they had demanded.
The drama over health subsidies is more than a policy dispute.
It is a symptom of a governing coalition whose core agenda—massive tax cuts for the wealthy paid for by stripping benefits from the poor and middle class, combined with a brutal, confrontational approach to immigration and domestic policy—has created a nation of crises.
As premiums prepare to spike, as ICE violence makes headlines, and as prices rise, the political cost is coming due.
The contortions of Van Drew and Kean are not the marks of legislators solving a problem.
They are the frantic gestures of politicians who have helped create a disaster and now fear being consumed by it.
The music is stopping, but Van Drew and Kean have no chair.
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