Washington (AP) — House Speaker Mike Johnson is imploring his fellow Republicans to stop venting their frustrations in public and bring their complaints to him directly.

“They’re going to get upset about things. That’s part of the process,” Johnson told reporters Thursday. “It doesn’t bother me. But when there is a conflict or concern, I always ask all members to come to me, don’t go to social media.”

Increasingly, they’re ignoring him.

Cracks inside the GOP conference were stark this week as a member of Johnson’s own leadership team openly accused him of lying, rank-and-file Republicans acted unilaterally to force votes and a leadership-backed bill faltered. It’s all underscored by growing worries that the party is on a path towards losing the majority next year.

“I certainly think that the current leadership and specifically the speaker needs to change the way that he approaches the job,” GOP Rep. Kevin Kiley of California said Thursday.

Kiley, who has grown vocally critical of Johnson after the GOP’s nationwide redistricting campaign backfired in California, said the speaker has been critical of rank-and-file Republicans, so “he needs to be prepared to accept any criticism that comes with the job.”

“And I think, unfortunately, there’s been ample reason for criticism,” he added.

GOP lawmaker asks, ‘Why do we have to legislate by discharge petitions?’

For the first part of 2025, Johnson held together his slim Republican majority in the House to pass a number of President Donald Trump’s priorities, including his massive spending and tax cut plan.

But after Johnson kept members out of session for nearly two months during the government shutdown, they returned anxious to work on priorities that had been backlogged for months — and with the reality that their time in the majority may be running out.

First was a high-profile discharge petition to force the vote on releasing the Jeffrey Epstein files, which succeeded after it reached the 218-signature threshold. Other lawmakers are launching more petitions, a step that used to be considered a major affront to party leadership.

“The discharge petition, I think, always shows a bit of frustration,” said GOP Rep. Dusty Johnson of South Dakota.

Another discharge petition on a bill that would repeal Trump’s executive order to end collective bargaining with federal labor unions reached the signature threshold last month, with support from seven Republicans.

And this week, GOP Rep. Anna Paulina Luna of Florida brought a long-anticipated discharge petition for a bill to bar members of Congress from trading stock. A number of Republicans have already signed on, in addition to Democrats.

“Anxious is what happens when you get nervous. I’m not nervous. I’m pissed,” Luna wrote on social media late Thursday, responding to leadership comments that she was overly anxious.

GOP Rep. Nancy Mace of South Carolina signed both Luna’s petition and the one to release the Epstein files. She told reporters Thursday that she expressed her frustrations directly to Johnson in a phone call, and in what she described as “a deeply personal, deeply passionate letter, that we are legislating by discharge petition.”

“We have a very slim majority, but I want President Trump’s executive orders codified,” Mace said. “I want to see his agenda implemented. Why do we have to legislate by discharge petitions?”

Speaker Johnson’s own leadership team is going after him

At the center of Johnson’s pleas for members to bring concerns to him privately instead of on social media is the chairwoman of House Republican leadership, New York Rep. Elise Stefanik.

Angered that a provision she championed wasn’t included in a defense authorization bill, Stefanik blasted Johnson’s claims that he wasn’t aware of the provision as “more lies from the Speaker.” She conducted a series of media interviews criticizing Johnson, including one with The Wall Street Journal in which she said he was a “political novice” who wouldn’t be reelected speaker if the vote were held today.

Johnson told reporters Thursday that he had a “great talk” with Stefanik the night before.

“I called her and I said, ‘Why wouldn’t you just come to me, you know?’” Johnson said. “So we had some intense fellowship about that.”

Asked if she had apologized for calling him a liar, Johnson said, “Um, you ask Elise about that.”

Illinois Rep. Mary Miller released a statement Thursday providing support for Johnson, saying that while there are differences among members “our mission is bigger than any one individual or headline.”

Democrats, who have had leadership criticisms of their own, have reveled in the GOP’s disarray. House Republican leaders attempted to muscle through an NCAA-backed bill to regulate college sports after the White House endorsed it, before support within Republican ranks crumbled. Some GOP lawmakers pointedly said they had bigger priorities before the end of the year.

“It’s not that Congress can’t legislate, it’s House Republicans that can’t legislate. It’s the gang that can’t legislate straight. They continue to take the ‘my way or the highway’ approach,” said House Democratic Leader Hakeem Jeffries.

There is underlying GOP unease about losing the chamber in 2026

All eyes in the U.S. House were on a special election Tuesday night in a Tennessee district that a Republican had won in 2024 by nearly 21 percentage points, with Trump carrying the area by a similar margin.

Republicans hoped the contest would help them regain momentum after losing several marquee races across the country in November. Democrats, meanwhile, argued that keeping the race close would signal strong political winds at their backs ahead of next year’s midterms, which will determine control of both chambers.

Republican Matt Van Epps ultimately won by nearly 9 percentage points.

“I do think to have that district that went by over 20 points a year ago be down to nine, it should be a wakeup call,” said GOP Rep. Don Bacon of Nebraska.

He argued that Republicans need “to get some economic progress, like immediately,” adding that “the president and his team have got to come to grips” that tariffs are not driving economic growth.

“I just feel like they’re going to have to get out of their bubble,” Bacon said of the White House. “Get out of your bubble. The economy needs improving. Fix Ukraine and we do need a temporary health care fix.”

Bacon is among a growing number of House Republicans who have announced they will retire after this term. Republican Rep. Marjorie Taylor Greene of Georgia abruptly declared last month that she would resign in January, citing multiple reasons, including that “the legislature has been mostly sidelined” this year.

Those retirements add to the GOP’s challenge in holding the House, as the party must now defend more open seats. Republicans have also seen a redistricting battle — sparked by Trump’s pressure on Texas Republicans and then more states — backfire in part. In November, California voters handed Democrats a victory by approving a new congressional map.

“That’s living in a fantasy world if you think that this redistricting war is what’s going to save the majority,” said Kiley, now at risk of losing his seat after redistricting in California.

He added, “I think what would make a lot bigger impact is if the House played a proactive role in actually putting forward legislation that matters.”

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Associated Press reporter Meg Kinnard in Columbia, South Carolina, contributed to this report.

One year after UnitedHealthcare’s CEO was shot and killed, the crisis in U.S. health care has gotten even worse — in ways both obvious and hidden.

People increasingly can’t afford health insurance. The costs of both Obamacare and employer-sponsored insurance plans are set to skyrocket next year, in a country where health care is already the most expensive in the developed world.

Yet even as costs surge, the companies and the investors who profit from this business are also struggling financially. Shares in UnitedHealth Group, the giant conglomerate that owns UnitedHealthcare and that plays a key role in the larger stock market, have plunged 44% from a year earlier. (It was even worse before a rally in UnitedHealth shares on Wednesday.)

“UnitedHealth’s reputation in the investment community, before December 4 last year, was [as] a safe place to put your money. And that basically got all blown up,” says Julie Utterback, a senior equity analyst who covers health care companies for Morningstar.

Then, on Dec. 4, 2024, United Healthcare CEO Brian Thompson was shot on a Manhattan street on his way to an investor event. The shocking act of violence sparked a widespread consumer outcry over U.S. health care costs and denied claims, and plunged UnitedHealth Group into a public relations disaster.

But that was only the start of the business woes for the company and its entire industry — which are facing regulatory scrutiny, tightening margins, and investor skepticism. Many of UnitedHealth’s top competitors have also seen their shares suffer in the past year, at a time when the stock market in general has been hitting tech-driven record highs. The S&P 500’s healthcare index has lagged the larger market. And some Wall Street analysts are bracing for another rocky year in the business of health care.

“Near term, there’s a lot more volatility to come,” says Michael Ha, a senior equity research analyst who covers health care companies for investment bank Baird.

Dec. 4 started to reveal the depth of U.S. health care problems

This wide-ranging crisis for both consumers and businesses underlines the brokenness of the U.S. health care system: When neither the people it’s supposed to serve nor the people making money from it are happy, does it work at all?

“We’re really at an inflection point,” says Katherine Hempstead, a senior policy officer at the Robert Wood Johnson Foundation and the author of a book about the insurance industry.

“Every segment of the health insurance business right now is stressed,” she adds.

These stresses became brutally visible a year ago — and persist today. Luigi Mangione, the 27-year-old suspect in Thompson’s killing, was in court this week for hearings ahead of his trial.

But the crisis in U.S. health care is much bigger than his case. Here are three main ways it’s playing out this year, from Main Street to Wall Street.

Prices are going up — and people are getting ready to go without medical care

No matter how you get your health insurance, it will likely cost more next year.

For the roughly 24 million people who get their insurance through the government’s health care exchanges, Affordable Care Act subsidies are set to expire at the end of the year — sending premiums soaring. Another 154 million people are insured through their employers — and premiums for those plans are also set to skyrocket.

Costs are increasing for several reasons: Drug companies have developed more effective cancer treatments and weight-loss drugs — which they can charge more for. More people are going back to the doctor after the pandemic kept them away, which is creating more demand and allowing providers and hospitals to increase prices. And some hospitals, doctors’ offices, insurance companies and other businesses within the health care system have merged or consolidated, often allowing the remaining businesses to raise prices for their services.

The end result is that nearly half of U.S. adults expect they won’t be able to afford necessary health care next year, according to a Gallup poll published last month.

Jennifer Blazis and her family are among them.

“It just always blows me away, how much I have to consider cost when something happens with the kids,” the 44-year-old nonprofit worker and mother of four told NPR this fall in an interview for its Cost of Living series.

Blazis and her family live in Colorado Springs and get their insurance through her husband’s small property-management business. She says she’s postponing leg surgery that would address a condition that’s causing her pain, but which her doctors say is not yet urgent.

“We wait to go to the doctor because we know if we do, we’re going to get hit with just a massive bill,” Blazis says. “And this is with … a really good health insurance plan that our [family] company pays a ton of money for.”

Yet even the biggest businesses selling these services are struggling

Some of those increased costs are also hitting insurers — even the ones that also control other parts of the health care ecosystem.

UnitedHealth Group is far more than just the owner of the largest U.S. health insurance company. It’s one of the largest companies in the world, and it’s involved in almost every part of how Americans access health care — from employing or overseeing 10% of the doctors they see to processing about 20% of the prescriptions they fill.

It’s also one of the most influential stocks on Wall Street. UnitedHealth Group is one of 30 companies that makes up the blue-chip Dow Jones Industrial Average — so what happens with its shares helps determine what happens with the overall stock market.

The company has had a miserable year on both fronts. The reasons come down to profits, more than PR: UnitedHealth and its competitors have been facing rising costs in the Medicare Advantage businesses that allow private insurers to collect government payments for managing the care of seniors.

These programs were once widely seen as money-makers for big health insurers – but now they’ve gotten UnitedHealth embroiled in financial and regulatory trouble, including a Department of Justice investigation into its Medicare business. The company abruptly replaced its CEO in May, a few months before it acknowledged that it was facing the government probe.

Now UnitedHealth is trying to get rid of about 1 million Medicare Advantage patients — and otherwise move on from the past year’s many problems.

“We want to show that we can get back to the swagger the company once had,” Wayne DeVeydt, UnitedHealth’s chief financial officer, told investors last month.

One prominent investor is betting it can: In August, Warren Buffett’s Berkshire Hathaway disclosed that it had bought more than 5 million shares in UnitedHealth Group. The news helped lift the stock from its depths — but it still has a long way to go for both its share price and its profits to recover from this year’s slump.

Chief Executive Stephen Hemsley acknowledged as much in October, promising investors “higher and sustainable, double-digit growth beginning in 2027 and advancing from there.”

Spokespeople for UnitedHealth declined to comment for this story.

Wall Street used to think health care was safe. It’s waiting for a turnaround

Health care spending accounts for about a fifth of the U.S. economy, making the for-profit companies that earn this money some of the most powerful in the world.

That’s helped their appeal to investors, who traditionally tend to consider health care stocks “defensive,” or safe, investments. That appeal sometimes overrides the industry’s current financial challenges: In the past month, as Wall Street had its now-quarterly panic over the artificial intelligence bubble, health care stocks actually outperformed the broader market for a few weeks.

Still, health care is massively lagging the market in the long term.

Morningstar’s Utterback is optimistic that the industry can eventually turn around its deeper financial, regulatory, and reputational problems. She even calls most health care stocks “undervalued” currently — but she warns that investors will have to have a lot of patience if they want to see bets on the sector pay off.

“My explicit forecast period is 10 years. It’s not three,” she says. “There’s a murky outlook here for the next couple years, at least.”