WASHINGTON – When state Rep. Jack McFarland, R-Winnfield, isn’t mulling complex finances as chair of the Louisiana House Appropriations Committee, he runs a logging contractor firm in Winn Parish.

As a small businessman with about 20 employees, McFarland frets about the lack of action on health care. Time is of the essence, and McFarland wants the warring parties in Washington to figure out a solution.

Republicans want to overhaul the Affordable Care Act to lower health care costs and increase consumer choice. Democrats are not opposed to fixes but argue that will take too much time, so first, the enhanced ACA marketplace subsidies need to be continued before expiring.

About 24.3 million working Americans and small businesses — 292,994 in Louisiana — will see their monthly costs double, on average, starting Jan. 1 if the subsidies are not extended. Disagreement on extending the tax credits was at the center of the government shutdown.

An ardent conservative in a parish that gave 88% of its votes to U.S. House Speaker Mike Johnson, R-Benton, McFarland agrees that substantial changes are necessary.

For instance, his employees can’t access the ACA marketplace.

Despite the promise in 2010 that the Affordable Care Act, also known as Obamacare, to lower health insurance premiums, it did not. The policy McFarland provided employees went from about $37,000 annually in 2011 to about $132,000 in 2024.

McFarland said his company had to stop covering premiums for his employees and now just pays a little to help. When some of his workers wanted to lower their costs by shifting to the ACA marketplace, they could not because his company offered health insurance, he said.

“As an employer, I would have to stop offering health insurance to all my employees for them to be eligible for subsidies,” McFarland said, adding that now many of his employees have no insurance.

Like most things that deal with health care and insurance, the Affordable Care Act is complex, with a lot of moving parts.

Obamacare protected people with preexisting conditions and made insurance available for those who couldn’t afford it. But the promise that premiums would decline because more people had insurance didn’t materialize.

Premium costs have risen from an average $177 per month in 2010 for individual policies, like the ones the ACA marketplace sells, to $467 per month in 2024, according to KFF, a Washington-based health analysis organization. Monthly costs for group insurance, like those offered by employers and cover roughly 170 million people, went up from an average $273 per month to $512 per month during the same period.

Senate Republicans are looking at various alternatives that align with President Donald Trump’s demand last week that the ACA subsidies go “directly to the people” rather than insurance companies.

In the House, Majority Leader Steve Scalise, R-Jefferson, told reporters Tuesday that House committee leaders also are looking at various ideas.

“We’re not here to bail out insurance companies,” he said. “We’re here to give families lower premiums and better options.”

But in both chambers, Democrats and Republicans are not talking officially to each other.

The Senate will need 60 votes to pass any GOP measure, which means seven Democrats have to sign on to any package that all the Republicans support — or eight Republicans have to agree with all the Democrats backing one of their ideas.

Right now, neither scenario looks likely when it comes to the key issue of whether to extend the enhanced ACA marketplace tax credits, which will get a vote in mid-December.

Senate Minority Leader Chuck Schumer, D-New York, said Thursday on the Senate floor that Republican ideas are “half-baked.”

“They are deeply flawed and woefully insufficient for our nation’s health care problems,” Schumer said. “When people’s monthly payments spike next year, they’ll know it was Republicans that made it happen.”

On Thursday, Johnson refined his oft-repeated accusation that Democrats only care about “illegal aliens” to point out what California, Illinois and Oregon spent more on health care for “noncitizens” than for police and roads.

Immigrants who slipped into the country without authorization are not legally allowed to take advantage of Obamacare. Legal immigrants who have jobs and children regardless of their status are allowed to buy insurance through ACA marketplaces. The Congressional Budget Office estimates that about 1.4 million immigrants have.

“Everybody’s just went to their corner and they’re just not coming out,” McFarland said. “It’s a broken system that needs to be fixed, not patched, for the people and for small businesses. They need to sit down and figure this out.”