Speaker Mike Johnson said health care needs real reform this week.

This would be required if Congress were to renew the enhanced Obamacare subsidies. Those subsidies are expiring at the end of the year.

Johnson spoke during a press conference about the controversial subsidies.

“The Covid-era Obamacare subsidy that they’re all talking about that’s supposedly the issue of the day doesn’t expire until the end of December. And by the way, it is the Democrats who created that subsidy, who put the expiration date on it. They put an end date on it because they knew it was supposed to be related to Covid, and it’s become a boondoggle. When you subsidize the health care system and you pay insurance companies more, the prices increase.”

The Speaker of the House spoke one day before the Senate will return to D.C. Democrats have shut down the government over expiring enhanced Obamacare subsidies.

Democrats first enhanced these subsidies with the $1.9 trillion Biden-era coronavirus stimulus plan. That was the American Rescue Plan. Democrats then extended these subsidies with the so-called Inflation Reduction Act.

These subsidies will expire at the end of the year.

The Speaker said that should Congress compromise and agree to continue the subsidies, American health care would need substantial reform.

“If indeed the subsidy is going to be continued, it needs real reform. But there’s a lot of ideas on the table to do that.”

NBC News asked Johnson about calls to repeal the Affordable Care Act. The Louisiana Republican responded with strong words about Obamacare.

“Obamacare failed the American people.”

He said it needs dramatic reform. However, he cautioned that he has post-traumatic stress disorder from Republican efforts during Trump’s first term. Republicans tried to repeal and replace President Barack Obama’s signature healthcare bill.

“Can we completely repeal and replace Obamacare? Many of us are skeptical about that now, because the roots are so deep. It was really sinister, the way, in my view, the way it was created. I believe Obamacare was created to implode upon itself, to collapse upon itself.”

Johnson’s comments reveal the Republican strategy on healthcare. Democrats are using the government shutdown to demand Obamacare subsidy extensions. They want these subsidies renewed without any reforms or changes.

But Republicans are pushing back. Johnson is making clear that any deal must include real healthcare reform. Simply extending the subsidies without fixes is unacceptable.

The Speaker correctly notes that Democrats created these subsidies. They also put the expiration date on them. The subsidies were supposed to be temporary measures related to COVID-19.

But Democrats want to make them permanent. They are willing to shut down the government to force Republicans to extend the subsidies.

Johnson calls the subsidies a boondoggle. This is accurate. When you subsidize the healthcare system, prices increase. Insurance companies get paid more. But consumers don’t see lower costs.

The subsidies have cost taxpayers billions of dollars. They were sold as temporary COVID relief. Now Democrats want to extend them indefinitely.

Republicans have a lot of ideas on the table for healthcare reform. Johnson hints that these reforms would be part of any deal. Democrats would have to accept real changes to the healthcare system.

Johnson’s comments about repealing Obamacare are honest and realistic. Many Republicans still want to completely repeal the law. But Johnson admits the roots are too deep now.

He calls the way Obamacare was created sinister. He believes it was designed to implode upon itself. This would force a government takeover of healthcare.

Johnson’s PTSD comment refers to the failed 2017 effort to repeal Obamacare. Republicans controlled the House, Senate, and White House. But they couldn’t pass a repeal bill.

Senator John McCain famously voted against the repeal. His thumbs down vote killed the Republican effort. This traumatized many Republicans who had promised to repeal Obamacare.

Now Republicans are more cautious. They know full repeal is probably impossible. But they still want dramatic reform of the system.

Johnson is laying out the Republican position. If Democrats want subsidy extensions, they must accept reforms. Republicans won’t simply rubber-stamp another extension.

The government shutdown gives Republicans leverage. Democrats need Republican votes to reopen the government. Republicans can demand healthcare reforms as part of any deal.

Johnson’s ideas on the table comment suggests negotiations are happening. Republicans are developing reform proposals. These would be included in any compromise bill.

The enhanced subsidies expire at the end of December. This gives Congress about two and a half months to reach a deal. But first Democrats must agree to reopen the government.

Republicans are willing to negotiate on healthcare. But they demand real reform. No more boondoggles. No more blank checks to insurance companies.