There’s one thing to know about the infuriating government shutdown
It's about health care, an issue that's coming back in 2026, 2028 and probably long after that.
One of the most tedious ordeals Americans ever have to deal with is a government shutdown. This never happens because of some unforeseen X factor. It’s always childish politicians who refuse to fund the government for a spell, to score points against their enemies and prove they can blow stuff up if they want to. Most voters just want to ignore it, if they can.
But there’s one element of the current shutdown, which began on October 1, that’s worth paying attention to, because it involves a crucial, long-running debate: How much should the government be involved in providing health care? The question dates all the way back to the establishment of Medicare and Medicaid in 1965, through the passage of the Affordable Care Act in 2010, and through Bernie Sanders’ call for “Medicare for all,” starting in 2016. Health care affordability will be a top issue in the 2026 midterm elections and in the 2028 presidential election.
Democrats are trying to tee up the issue now. The House of Representatives has already passed a spending bill to keep the government functioning. But Republicans who have 53 seats in the Senate need at least seven Democratic votes to overcome the filibuster and pass the spending bill. Democrats have little leverage in Congress, but they do have blocking power on the spending bill.
They’re refusing to approve the Republican package because it doesn’t contain an extension of tax credits that lower the cost of health insurance under the Affordable Care Act. Congress first enacted those tax credits in 2021, Joe Biden’s first year as president, when Democrats controlled both houses of Congress. Those credits expire at the end of 2025.
If they do run out, about 4 million people will lose coverage, according to the Congressional Budget Office. Millions of others will face premium increases of more than 100%, according to KFF. This would come after Republicans passed a tax package over the summer that will eventually leave 16 million people without health coverage, because of cuts to Medicaid and other programs.
Democrats have made the strategic decision to risk getting blamed for a shutdown because they think it’s worth using the ruckus to call out Republicans for cutting health care. Voters loathe and pity the hapless Democrats, yet health care is a strong point for the party. Maybe the only one.
The government spending bills aren’t the only chance to extend the ACA credits. Republicans say they can take up the ACA subsidies in separate legislation once Congress passes the spending bills. That’s technically true. The spending bills run out every year on September 30 because that’s the end of the government’s fiscal year. That’s why the shutdown is happening now. But the ACA tax credits don’t expire until December 31. So there are still three months to tackle that issue.
The obvious question is whether Republicans who control Congress would extend the ACA credits later this year, given the long record of GOP antipathy toward the ACA, aka “Obamacare.” Trump vowed to repeal the ACA during his first term, and he almost succeeded. Since then, however, the ACA has grown in size and popularity. It now provides coverage for 24 million Americans. The program’s approval rating has surged from a low of 33% in 2013 to 66% now.
It’s a myth that the ACA mainly helps Democrats or people who live in Democratic districts. A June survey by KFF found that 45% of ACA enrollees were Republicans, while 35% were Democrats and 20% Independents. A separate KFF analysis found that 27% of farmers and ranchers—generally a Republican constituency—get coverage through the ACA.
Republicans have long argued that the ACA is too expensive, and that’s part of their problem with the tax credits due to expire. Extending them would cost about $35 billion per year, at a time when annual federal deficits are grotesquely large. Yet Republicans just passed a tax bill that will add $4 trillion to the national debt during the next decade and cut the average tax bill of the top 10% of earners by nearly $14,000 per year. Democrats want everybody to be aware of that contrast.
Once a shutdown is underway, there’s an epic propaganda battle among the two parties to blame each other and win a kind of attrition battle in the minds of voters as they try to decide which party they hate the least. One Republican claim, this time around, is that Democrats are holding out on the spending bill so they can extend ACA coverage to “illegal aliens.” That’s bunk. ACA coverage is not available to undocumented people and Democrats aren’t proposing anything that would change that.
Democrats say the GOP spending bills would give Trump a “blank check” to spend anything he wants, which is misleading. Dems are trying to conflate other Trump efforts to unilaterally shut down government agencies and redirect Congressionally appropriated funds with the spending standoff.
Many Americans will tune out the shutdown theatrics, and even if they don’t it will be hard to tune in the substance amid the clatter of blame and counterblame. But many voters don’t need a shutdown drama to know the cost and availability of health care is an ongoing strain. The loudest politicians can’t drown that out.