DES MOINES, Iowa (Gray Media Iowa State Capital Bureau) -- Health care is on the minds of a lot of people right now. Open enrollment is underway for people who have health insurance coverage. The process may also illustrate how costs keep climbing.

But political decisions may also determine which Americans keep their coverage, which ones may no longer be able to afford it, and how much taxpayers should subsidize different plans.

Medicaid work requirements, Republican reductions to federal taxpayer support for Medicaid health insurance coverage, and the end of enhanced premium tax credits for the Affordable Care Act (scheduled to sunset at the end of the year) could all impact health care.

Extending the ACA tax credits could cost taxpayers $350 billion over the next decade, according to

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