House Speaker Mike Johnson said today he will not call for a vote on extending enhanced subsidies for people buying insurance through the Affordable Care Act.

That effectively guarantees the subsidies will expire at the end of the month, and premiums will spike substantially for some 20 million Americans who get their coverage that way.

In a moment, we'll hear from Republican Senator Bill Cassidy,

who's a key player in this debate. But before we do, we turn to the first of two reports

on the subsidies and alternative ideas. William Brangham focuses tonight on how the subsidies

work and what's at stake if they expire.

Tens of millions of Americans will be a whole lot healthier from this moment on.

It was March 23, 2010, and Vice President Biden whispers in President Obama's ear,

this is a big effing deal.

And it was, signing of the Affordable Care Act into law. Today, after all the votes have been tallied, health insurance reform becomes law in the United States of America.

It was complicated to pass and complicated in its structure, but the ACA, which was quickly dubbed Obamacare, had a fairly straightforward goal,

expand health care coverage, and keep costs down.

And over the ensuing 15 years, the ACA has been mostly successful on that first front

by expanding Medicaid and by helping people buy insurance.

All of that helped cut the uninsured rate in half.

But that promise of lower prices, what President Obama often called, bending the cost curve,

that has been a much harder nut to crack.

In the United States, we spend twice as much money on health care as many other countries

do.

Cynthia Cox analyzes the Affordable Care Act at KFF.

The ACA worked by using taxpayer dollars to reduce the cost of health care for individuals that

qualify for those programs, but it didn't do a whole lot to address the underlying reasons

...