For nearly 40 days, Democrats have battled with Donald Trump’s administration, refusing to give in to the president’s pressure to reopen the federal government. The consequences of the longest government shutdown in US history were not small: massive layoffs of federal workers, chaos in the country’s main airports, interruption of the food stamp program on which one in eight Americans depends… Democrats resisted because at stake was access to medical care for millions of people, who can afford insurance thanks to federal subsidies that expire at the end of the year and whose renewal has kept the two parties at odds for more than a month. Now, with a deal in sight to end the administration’s shutdown, access to affordable health care is once again in jeopardy.
Last Sunday, seven Democratic senators changed sides and, together with another independent senator, facilitated the agreement that will be voted on this week in Congress and which will then go to Trump’s desk to end the partial government shutdown. In addition to independent Rep. Angus King (Maine), Senators Tim Kaine (Virginia), Dick Durbin (Illinois), John Fetterman (Pennsylvania), Jeanne Shaheen (New Hampshire), Catherine Cortez Masto (Nevada), and Jacky Rosen (Nevada) gave in on the condition that their party be deemed non-negotiable. Republicans, in exchange for support, pledge to vote on subsidies only in December; a vague promise that doesn’t convince.
“The government shutdown may be over, but the fight to contain health care costs must continue,” Anthony Wright, executive director of Families USA, a health care rights organization, said in a statement Monday. The millions of Americans who buy their own health insurance now “risk facing skyrocketing premiums or losing their coverage altogether. We are deeply disappointed that this deal includes only the promise of a future vote on extending premium tax credits,” he added.
Subsidies that expire at the end of the year are part of the Affordable Care Act (ACA), known as Obamacare, because it was during the presidency of the Democratic leader that it was approved. Barack Obama’s administration designed the rule so that millions of people who lacked access to health care could afford health insurance, which they accessed through a marketplace that offered lower prices. The subsidies they receive to buy insurance were approved during the pandemic and will likely disappear starting in January, because to get the support needed to pass budgets, the government did not need to budge in this area.
In a country where medical care prices are so exorbitant that they turn healthcare into a luxury, approximately 24 million people have insurance through Obamacare, a number that has doubled since subsidies were increased in 2021.
These tax credits benefit low- and moderate-income people who do not receive health insurance through an employer or other government program. Restaurateurs and retailers, small business owners and employees, barbers, hair stylists and temporary Uber workers, ranchers, farmers, musicians and artists, real estate agents, dentists… These are workers whose income is not low enough to qualify for the Medicaid program, reserved for the poorest, but who cannot afford to pay for insurance, so they depend on subsidies. These guarantee that bonuses do not exceed 8% of their salary.
Without this help, that percentage could skyrocket to 25% of their salaries. For example, for someone paying $400 a month, the premium could increase to $1,400 a month. Experts estimate that about four million people will be left without health insurance because they cannot afford it.
President Trump already unsuccessfully attempted to repeal the law during his first term. Last weekend he reiterated his intention to eliminate subsidies, posting on his Truth social network that they were “a boon to health insurance companies and a DISASTER for the American people.”
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It remains to be seen how the loss of subsidies will affect the 2026 midterm elections. This year, 18.7 million (77%) of the 24.3 million total ACA enrollees live in states where President Trump won the 2024 election.
Public support remains high for extending the ACA tax credits, with three-quarters (74%) of the public in favor of keeping them, according to a recent poll conducted by KFF, an independent health research organization.
According to the same poll, more than half (55%) of those who buy their health insurance, most through the ACA marketplaces, say Democrats should reject a budget that doesn’t include an extension of subsidies. Ahead of next year’s elections, polling shows signs that voters are giving the Democratic Party an edge on issues related to health care costs. When asked which party they believe is most trusted to best manage the future of the ACA, a greater percentage of voters lean toward the Democratic Party (43%) than the Republican Party (32%).
