Karl Rove, former White House Deputy Chief of Staff and Republican strategist, isn't mincing words about his party's prospects heading into 2026. Without a concrete health care plan paired with solid economic policies, the GOP is setting itself up for what he calls "deep trouble" in the midterm elections.

The Economy, Stupid—Plus Health Care

During a Saturday interview on Fox News's Journal Editorial Report, Rove delivered a message that probably made some Republican operatives squirm. He urged the party to dust off the old playbook and remember James Carville's famous 1992 line: "It's the economy, stupid."

But here's the thing—the economy alone won't cut it this time. "The Republicans have got to have a health care agenda, otherwise they're going to be in deep trouble," Rove emphasized. He's pushing for "pro-growth policies" coupled with forward-looking initiatives that actually address what voters care about.

The ACA Subsidy Cliff Is Coming

Health care isn't just a theoretical concern. It's become a pressure point this year, exemplified by a record-long government shutdown over Affordable Care Act subsidies. Those enhanced subsidies are scheduled to expire at the end of this year, which could mean significantly higher premiums for millions of Americans—including a good chunk of Republican voters.

That's not exactly the kind of messaging the GOP wants heading into a competitive election cycle.

Rove also noted that fractures are appearing within the Republican Party as lawmakers get increasingly nervous about midterm outcomes. The problem? Voters haven't yet felt the promised benefits of President Donald Trump's tax and spending bill.

"If the president's 'big, beautiful bill' was as instantaneously positive as he thinks, his approval numbers on the economy wouldn't be in the 30s, and his overall approval wouldn't be in the low 40s," Rove said.

Mixed Signals on What Comes Next

Last week, President Trump said he didn't want to extend Obamacare subsidies, though the White House has explored short-term options to prevent premium spikes. He rejected a two-year renewal of expanded ACA subsidies but left the door open for some kind of extension—whatever that might look like.

The lack of clarity has created internal party tensions. Last month, former Transportation Secretary Pete Buttigieg criticized Trump's policies as a "bad deal" that could push premiums up by 10% in 2026. He also called the president's attacks on air traffic controllers a distraction from the economic pressures facing everyday Americans.

Meanwhile, in October, Rep. Marjorie Taylor Greene (R-Ga.) accused House Speaker Mike Johnson (R-La.) of keeping GOP plans to replace the ACA under wraps. She demanded specifics on the expiring subsidies and urged Senate leadership to consider aggressive measures to pass funding legislation.

The clock is ticking, and Rove's message is clear: get your house in order, or prepare for voter backlash.