The ongoing government shutdown has sparked a heated debate over healthcare, with conflicting messages from Capitol Hill. At the heart of this battle is the extension of Affordable Care Act (ACA) tax credits, which Democrats argue is urgent, while Republicans believe there's time to resolve it.
But here's where it gets controversial...
While this may seem like a political messaging war, it has real-world implications for millions of Americans. These are not just abstract policies; they directly impact the health insurance marketplaces where people buy coverage. The federal government's contribution to monthly premiums significantly affects the accessibility and affordability of healthcare for 24 million individuals.
So, let's dive into five key facts about this policy debate:
- Public Support for Subsidies: A recent KFF poll revealed that an overwhelming majority (78%) of people, regardless of political affiliation, support Congress extending the enhanced ACA tax credits. This includes Democrats, independents, Republicans, and even Make America Great Again supporters. Ashley Kirzinger, KFF's director of survey methodology, emphasizes that "the public wants Congress to act."
Other polls, like the one conducted by Republican pollsters Tony Fabrizio and Bob Ward, also found strong support for extending the policy, with 72% of voters across parties in favor. In their words, "Voters don't want to see people losing their health insurance."
Urgency for Open Enrollment: North Dakota's Insurance Commissioner, Jon Godfread, emphasizes the need to extend the enhanced subsidies before open enrollment on November 1st. He urges lawmakers to "do this now" to ensure consumers see subsidized rates when they shop for plans. If Congress misses this deadline, consumers may face significantly higher premiums and may not return, even if the credits are eventually extended by December.
Premiums Set to Skyrocket: When setting rates for 2026, health insurers considered the rising healthcare costs and the potential expiration of subsidies, which could drive the healthiest individuals out of the ACA marketplaces. KFF researchers analyzed insurance filings and found that premiums will double for many consumers next year. Cynthia Cox, director of the Program on the ACA at KFF, warns that this could lead to people opting to go uninsured. The Congressional Budget Office estimates that 4 million people could become uninsured if the enhanced tax credits expire.
Majority of Enrollees in Trump-Won States: The people relying on HealthCare.gov and other Obamacare marketplaces are often those without coverage offered by their employers, such as small business owners, farmers, ranchers, and gig workers like Uber drivers. Geographically, more than 3 in 4 enrollees live in states won by President Trump in 2024. This includes states like Texas, Louisiana, Mississippi, Tennessee, Georgia, and West Virginia, where enrollment has more than tripled in the last five years.
Costly Subsidies for the Government: While the subsidies have kept costs down for consumers, they come at a significant cost to the federal government. The Congressional Budget Office estimates that extending the enhanced subsidies permanently would cost the government $350 billion over the next decade. Conservative groups opposed to the Affordable Care Act argue against these subsidies, stating that they were meant to be temporary during the COVID-19 pandemic and extending them will drive up healthcare costs.
However, some Republicans, like Rep. Marjorie Taylor Greene and Sen. Josh Hawley, support extending the tax credits or finding an alternative plan to prevent dramatic rate hikes for consumers.
Godfread acknowledges the debate over rising healthcare costs but emphasizes the urgency of the current situation. He argues that while these discussions are important, they are separate from the immediate need to ensure access to healthcare for consumers, which the subsidies have helped provide.
