By Sam Janesch and Evan Robinson-Johnson, Pittsburgh Post-Gazette
WASHINGTON — Lynn Weidner, a 42-year-old home care worker from Allentown, had already spent much of this year frustrated with her congressman by the time she finally sat down for a meeting with his staff at the beginning of last week.
She’d reached out repeatedly to U.S. Rep. Ryan Mackenzie over his support for President Donald Trump’s One Big Beautiful Bill in the summer and then — once she found out her premiums on the Affordable Care Act exchange would jump by 50% — for his decision to stand with other House Republicans during the government shutdown that Democrats forced to address the health care issue.
As Congress inched toward an end-of-year deadline on the Obamacare subsidies, she secured a meeting with Mackenzie’s district staff.
“If he [doesn’t] do the right thing, I will do anything in my power to make sure he’s out of office next year,” Weidner said she told his staff. “I don’t play around when it comes to that.”
Two days later, Mackenzie became one of only four House Republicans to buck his party’s leadership, joining Democrats to force a vote on extending the subsidies that have kept Weidner’s and 24 million other Americans’ premiums affordable.
Congress ultimately left town for the holiday break without a solution. But Mackenzie’s move in the final hours of debate underscored the powerful political force that health care costs are now likely to play in next year’s midterm elections, and in the Keystone State in particular.
Two of the other four House Republicans to support Democrats’ three-year extension, like Mackenzie, represent highly competitive districts that Democrats are targeting to win back some semblance of control in Washington.
U.S. Reps. Brian Fitzpatrick, of Bucks County, and Rob Bresnahan, of Luzerne County, said last week that their decisions to support the extension were because their constituents are set to see skyrocketing costs.
Political observers say they may also have had something to do with political survival.
“Everybody’s going to know somebody who experiences this,” said Berwood Yost, director of the Center for Opinion Research at Franklin & Marshall College. “Their behavior [Wednesday] tells me they realized this. This is why they voted for that discharge petition.”
Yost said the increases set to take effect in January will pile onto the anxieties around affordability that his and other polls have indicated are top-of-mind for many Pennsylvania voters.
Chris Borick, director of the Muhlenberg College Institute of Public Opinion, echoed that thought, adding that health care concerns are “particularly salient in American politics.”
He pointed to widespread Republican victories in the U.S. House in 1994 and 2010, after Democratic Presidents Bill Clinton and Barack Obama focused on health care policy in their first years in office.
And in what could be a kind of deja vu for Republicans this year, Trump’s first two years in office were punctuated with a 2018 midterms where Democrats swept into the House majority by aggressively campaigning on GOP attempts to dismantle the Affordable Care Act. By the time voters went to the polls that year, half of all campaign ads across the country were about health care, and 4 in 10 voters said it was their top issue.
“Republicans paid a price when their promise to fix health care didn’t materialize,” Borick said. “In 2026, the conditions are ripe for health care to have an enormous impact on the ultimate results in the midterms. And that’s, in many ways, quite intimidating for Republicans. Because they own it right now.”
Political finger-pointing
Even Republicans who didn’t go against their party leadership have acknowledged that ownership — as well as the stakes for both their constituents and their party.
U.S. Sen. Dave McCormick, a Pennsylvania Republican finishing his first year in office, won’t be on the ballot again until 2030. But in a telephone town hall with constituents this month, he railed against Democrats for setting up the expiring subsidies even as, he said, it was his party’s job to fix it now.
U.S. Rep. Glenn Thompson, a Centre County Republican who represents parts of Western Pennsylvania, told the Post-Gazette the GOP was “looking at health care because we know it’s a real need.”
A longtime lawmaker who was newly elected when he voted against the passage of the Affordable Care Act in 2010, Thompson said Republicans should get credit for their efforts to expand rural health care and paving the way for telemedicine.
“The mistake we made is we don’t talk about it enough,” Thompson said. “We don’t celebrate those. And then innovations that Republicans have led, specifically telemedicine, I was the tip of the spear on that.”
He also accused Democrats of politicizing the issue.
“I hope my Democratic friends will support it,” he said of the GOP leadership bill that claimed to lower premium costs by 11%. “Although, there are some of them, I believe, that they love having this issue. Because they weaponize it for politics, and maybe that’s part of the problem of why we haven’t had a solution up to this point.”
U.S. Rep. Mike Kelly, a Butler Republican who, like Thompson, represents a solidly Republican district, also supported House Speaker Mike Johnson’s plan last week. He told constituents in a weekly email newsletter that “House Republicans are working to lower the burdensome costs of health care for all Americans not only for the next year, but for years to come.”
The bill from Johnson passed the House with only GOP votes on Wednesday. It was not immediately considered by the Senate, which rejected a similar plan a week earlier, and then lawmakers adjourned for the year.
Fitzpatrick — just before a plan he crafted to extend the subsidies and implement other reforms was shot down Tuesday — countered his party’s own talking points while pleading with them to compromise.
“Take politics, take all of that stuff, out of the equation,” he said.
‘An enormous amount of messaging’
In the narrowly divided U.S. House, Democrats need to flip only three seats to win a 218-person majority in 2026.
And between the three eastern Pennsylvania districts and the Harrisburg district represented by conservative U.S. Rep. Scott Perry, Pennsylvania is set to have more competitive races in Republican-held seats than any state in the country, according to a trio of often-cited election ratings experts.
Mackenzie’s and Perry’s seats are considered the biggest toss-ups. They won their elections in 2024, a strong year for Republicans nationwide, by about 4,000 votes and 5,000 votes, respectively, out of a little over 400,000 votes each.
Voter registration and voting history in Bresnahan’s district leans a little more Republican but is still competitive, and Fitzpatrick has consistently won in his competitive seat since he succeeded his brother in 2017.
J.J. Balaban, a Philadelphia Democratic strategist and admaker for Perry’s challenger, said it’s too early to say if health care will specifically dominate the avalanche of television and digital ads that voters will see in 2026. But he said it will definitely be part of the mix.
“There will be an enormous amount of messaging on the cost of living and on affordability issues,” Balaban said.
He said the challenge for Republicans is similar to the challenge that Democrats faced in 2024.
“The Biden administration tried, they gave it the old college try, to convince people the economy isn’t so bad. And that was widely seen as a failure,” Balaban said. “Now basically Trump and the Pennsylvania Republicans in Congress are singing from the same songbook to see if they can make it work. And maybe they can, but the challenge is the data shows that people are even angrier about the economy now than they were in 2024.”
Yost pointed to his F&M poll of Pennsylvania registered voters in October that found 36% said they were “worse off” financially compared to a year earlier. Only 16% said they were “better off” financially.
Democrats like U.S. Reps. Chris Deluzio and Summer Lee, who both represent district in western Pennsylvania, have been shining a spotlight on those concerns as they’ve tried to draw attention to the health care cliff and Republican policies.
Deluzio, whose district is also relatively competitive but considered safer for him in 2026, has been active on the campaign trail — visiting Perry’s district for an event with Democratic challenger Jenelle Stelson and boosting other Democrats going up against Mackenzie and Bresnahan.
He said in an interview last week that the way those members of Congress vote affect his constituents in Allegheny and Beaver counties, and he’d “like to see very different votes out of those districts.”
“That means different members,” he told the Post-Gazette. “So I’m going to do what I can do to protect my constituents, support candidates out there who can win, and take some basic action, minimum action, to bring down healthcare costs.”
Weidner, for her part, said Mackenzie’s move last week “will probably help him with some moderates or some conservatives who may have been upset about the healthcare issues.” After Mackenzie and the other moderates also voted for the Republican leadership’s proposal, though, she said her trust for him to keep voting on health care policies that benefit her isn’t there.
But it also likely won’t be the last time Mackenzie breaks from his party in a noticeable way, said Sam Chen. An Allentown GOP strategist, Chen has worked against Mackenzie in previous Republican primaries and said Mackenzie’s “intelligence and work ethic” are routinely underestimated. He said he expects him to try to show his independence a few more times in a way that will appeal to critics and not alienate supporters of Trump.
“He stops at nothing to win and he’s very good at what he does,” Chen said. “It’s an uphill climb because of the demographics and the way the winds are blowing, but I actually think Bresnahan’s seat is going to be an easier pickup for Democrats than Mackenzie’s.”
Yost said the challenge for Mackenzie and Bresnahan in particular is that they’re “really vulnerable” as first-term representatives who, unlike Fitzpatrick, has “behaved this way consistently” for nearly a decade in office.
“At some point, you’re beholden to your voters,” Yost said. “And if you’re in a competitive district, then they better see you as being responsive. The question is, ‘Is it enough?’ ”
