As millions of Americans brace for soaring health care costs, President Donald Trump is confronting an open rupture inside his own party that lawmakers fear could haunt Republicans in the 2026 midterm elections.

U.S. patients already face among the highest medical bills in the world, spending more than twice as much on average as people in other wealthy nations, according to the Organisation for Economic Co-operation and Development (OECD).

The latest flashpoint is the year-end expiration of Affordable Care Act (ACA) subsidies that help cash-strapped families buy health insurance — a deadline that has laid bare a widening gulf between Trump’s blue-collar coalition and establishment Republicans determined to let the aid lapse.

Fiercely opposed to anything resembling support for the ACA —

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