Podcast Summary: Bulwark Takes – "Why Some Republicans Secretly Want to Help Obamacare"

Featuring: Senator Tammy Baldwin

Date: September 17, 2025

Host: Jonathan Cohn (The Bulwark)
Guest: Senator Tammy Baldwin (WI, Senate HELP Committee)

Main Theme & Purpose

This episode dives into the current battles over U.S. healthcare policy, focusing on the imminent expiration of enhanced Obamacare premium subsidies, the potential for health insurance costs to spike, and the growing debate within both parties about the future of the Affordable Care Act (ACA). Senator Tammy Baldwin shares her personal healthcare story, outlines the stakes in the ongoing negotiations, and gives an insider’s look at bipartisan dynamics, secretly supportive Republicans, and the added tensions around public health under RFK Jr.'s leadership.

Key Discussion Points & Insights

1. Why Healthcare Policy Matters to Senator Baldwin

• Personal Story:
  • Raised by grandparents, Baldwin grew up uninsured due to a loophole that excluded non-dependent grandchildren from coverage. When she got a serious illness at nine, her family faced massive bills because pre-existing condition exclusions prevented her from gaining insurance.
  • Quote [02:13]:

    "When I was sick, when I was in the hospital, my grandparents ended up, you know, needing to pay all those bills out of pocket…there was no obligation on the part of health insurance companies to cover somebody who had what they call a pre-existing health condition." (Senator Baldwin)

  • Her experience led to key provisions in the ACA, especially allowing young adults to remain on their parents' plan until age 26.

2. Background on the ACA Subsidies Debate

• In 2021, extra subsidies made insurance more affordable for millions—these are set to expire at year end unless Congress acts.

• Potential ramifications: over 20 million Americans could see insurance premiums spike, with millions potentially losing coverage.

• Awareness:

  • Baldwin notes that public awareness is growing as open enrollment approaches and people begin receiving notices about premium increases.
  • Small business owners, self-employed workers, and rural communities face disproportionate impact.
  • Quote [08:13]:

    "I'm hearing from a lot of constituents, especially folks who may be a small business owner and use the marketplace for themselves and their employees or self-employed individuals…As an entrepreneur, you're the one who has to make sure that there is a healthcare benefit." (Senator Baldwin)

3. Republican Arguments and Baldwin’s Rebuttal

• Republicans opposing extension argue the pandemic-driven emergency is over, and the program’s ~$30-40B/year cost is too high.
• Baldwin’s Counter:
  • The subsidies stabilized the insurance market and dramatically increased coverage rates.
  • Rolling them back could destabilize markets and spike uninsurance rates by 15 million, impacting everyone.
  • Quote [10:07]:

    "We just dramatically increased the number of Americans who had health insurance coverage...That's something we want to keep up because...about 15 million people are predicted to lose their healthcare in the coming years." (Senator Baldwin)

4. Democratic Negotiation Strategy

• Democrats have leverage: government can't pass funding without their votes.
• Internal debate: should Democrats push for a short-term extension or demand permanent subsidies plus restoration of Medicaid and NIH research funding?
• Baldwin’s Position:
  • Favors a bold, comprehensive ask including permanent ACA subsidies, reversal of Medicaid and research cuts, and enforcement to prevent the administration from withholding authorized funds.
  • Quote [13:31]:

    "Let's repair the incredible damage that Republicans have done...extend permanently the ACA tax credits, restore Medicaid and NIH research cuts, and put in enforcement provisions..." (Senator Baldwin)

5. Bipartisanship: Secret GOP Support?

• Some Senate Republicans privately acknowledge the damage that premium spikes could cause, especially in rural states, and are open to compromise.
• Challenge: GOP leadership pressures, reluctance for a permanent solution, and efforts to separate ACA subsidies from must-pass spending negotiations.
• Quote [16:19]:

  "I do have several Republicans who...want to extend these premium tax credits because they understand the devastating impact that seeing them lapse would have...privately, quietly, they talk to me about a path forward." (Senator Baldwin)

6. The RFK Jr. Effect on Public Health Policy

• RFK Jr., a controversial figure, is facing bipartisan skepticism about his vaccine stance and public health decisions.
• Not all Republicans embrace his agenda; some have directly challenged his testimony and regret confirming his nomination after broken promises.
• Quote [18:52]:

  "I know because Senator Cassidy said it aloud...He named about four, five things that RFK Jr. pledged to him. And it appears to me that he's broken all of those commitments." (Senator Baldwin)

• Committee hearings are upcoming to probe CDC ouster and RFK’s management style.

7. Medical Research Funding & Leverage

• Massive NIH cuts proposed, but the Senate Appropriations Subcommittee (on which Baldwin serves) is fighting to restore and even increase NIH funding, installing stricter enforcement so that the Administration cannot withhold spending.
• Quote [21:35]:

  "...we have not only restored the 40% proposed cut...we've actually increased funding...with enforcement language that says it needs to be spent on a timeline that is appropriate." (Senator Baldwin)

Notable Quotes & Memorable Moments

• On Pre-existing Condition Discrimination:

  "You just couldn't get insurance...I just grew up feeling like this was wrong, that this was a system that was totally broken." (Senator Baldwin, [02:57])

• On Market Stability:

  "When you have a more stable health insurance market, everyone is advantaged." (Senator Baldwin, [09:51])

• On GOP's Quiet Calculus:

  "They privately, quietly, talk to me about a path forward." (Senator Baldwin, [16:19])

• On RFK Jr.'s Broken Promises:

  "I've got to imagine there's a regret...some of my Republican colleagues who felt as though they got commitments from him." (Senator Baldwin, [18:52])

Timestamps for Key Segments

• [02:13] Baldwin’s childhood healthcare experience and inspiration for advocacy
• [06:06] ACA timeline, enhanced subsidies, and what's at stake
• [08:59] The Republican argument against continued subsidies; Baldwin's economic rebuttal
• [12:21] Democratic strategy question—permanent vs. temporary extension and negotiation priorities
• [13:31] Baldwin outlines Democrats' leverage and response to partisan House proposal
• [16:19] Off-the-record Republican support for ACA subsidies and negotiation subtleties
• [17:59] Robert F. Kennedy Jr.'s effect on GOP and vaccine policy; preview of CDC hearing
• [21:35] Medical research and NIH—Congressional efforts to restore funding

Episode Tone & Style

• Conversational and informed, with Baldwin drawing from personal history and on-the-ground Senate negotiations.
• Tone is serious, urgent, but practical—focused on real consequences and behind-the-scenes political calculations.

Summary Takeaway

This episode reveals the high stakes of the ACA premium subsidy debate, detailing both the public arguments and the private, bipartisan support that could lead to an unexpected resolution. Senator Baldwin shares how her personal history shaped her policy priorities, defends the necessity of continuing expanded coverage, and pulls back the curtain on how the real power plays are happening in Congress. Listeners walk away with deeper insight into both the fragility and resilience of the current U.S. healthcare system—and the pivotal role quiet, cross-aisle conversations may play in saving it.