It is not surprising that Republicans are struggling to agree on whether to extend expiring subsidies for health insurance enrollment. For a decade, the party has avoided getting behind a larger plan, which allows factions to form when considering incremental steps. The resulting divisions create paralysis.

President Trump’s recent fits and starts are just the latest example of a repeated pattern. In the span of six days, he stated in a social media post that he would never accede to an extension of premium credits for Affordable Care Act (ACA) insurance and then later teased support for doing just that (albeit only if paired with other reforms). The blowback from House Republicans, who liked the first message but not the second, was immediate and forced the White House into a retreat. Similarly wild swings doomed the GOP’s “repeal and replace” push in 2017.

It is not that the GOP needs a fully baked or comprehensive plan to engage in the enhanced credit debate, but it would help if it had an overall goal in mind when its leaders collectively think through their positions. Right now, some House and Senate members are clearly worried about a spike in the ranks of the uninsured next year, while others seem unconcerned.

The following are some points that might be considered as the party tries to find a way forward.

• Access to affordable health insurance for all American citizens and legal residents is a worthy, popular, and achievable goal. The Republican party has not made enrollment in health insurance a priority out of concern that doing so would lead to policies it finds objectionable (such as mandatory enrollment). However, ambivalence on this matter is hurting the party too because voters sense some Republicans might be fine with a new surge in the ranks of the uninsured due to unaffordable premium rises. That prospect helps Democrats press their case for ever more generous federal subsidies. Most Americans believe it is important to have health insurance, and the balance of the credible evidence supports that perspective.
  
  The GOP would be better off agreeing with this consensus position when formulating policies. The implication is that opposition to ACA coverage should be paired with realistic alternative plans.
  
  Among the policies the party might consider adopting are: providing credits to low-wage workers so they can enroll in employer coverage instead of ACA plans; allowing employers to use automatic enrollment to sign more people up with the plans they offer (workers would retain the right to disenroll later); encouraging the remaining ten non-expansion states to offer Medicaid to all persons below the federal poverty line (FPL) in exchange for greater flexibility in covered benefits and other rules; and allowing insurers to charge penalties to persons who have sufficient incomes to pay premiums but voluntarily opt out of coverage and then later try to get back into the market.
  
• Persons with pre-existing conditions should not be priced out of insurance. Republicans are uncomfortable with regulation, but health insurance markets break down without some rules. Adverse selection will occur if insurers are allowed to set premiums based on health risks. There are multiple ways to address the problem, but the GOP needs to make it clear to voters that it will support practical rules to protect people who present higher insurance risks.
• Markets can work in health care but require structure. The Democrats want to use the power of federal regulation to control costs, but that approach invites a slow erosion in the quality of the services provided to patients. Government price restrictions push some suppliers out of the market and reduce the incentive of talented individuals to secure the necessary training to become licensed clinicians. Republicans are right to believe markets offer a better solution, but only if those markets have boundaries that allow consumers to easily identify high and low-value options.
  
  More specifically, Republicans should take the next steps in price transparency rules by forcing providers to offer all-in pricing for high-volume services and procedures. Patients should be able to quickly identify which providers are charging more than others for standardized bundles of care (for instance, for common surgeries such as hip replacements).
• Effective markets require robust competition. The health sector is overly consolidated. Republicans (nationally and at the state level) should commit to fighting practices that undermine price competition. They should make it easier for new facilities to be built, which will compete with incumbent systems, and they should prevent specialist physician groups (such as for anesthesiology) from becoming monopolies in certain markets.

Over the next month and into 2026, Democrats will press the case that only they have a realistic plan for ensuring Americans can get affordable insurance. Republicans should offer voters a practical, market-based alternative that does not contest that population-wide insurance access is a worthy objective.