ACA health care plans are at the center of the shutdown fight : NPR

Democrats talk about extending Affordable Care Act tax breaks urgently. Republicans say they still have plenty of time to figure it all out.

As the government shutdown continues, there are many mixed messages on Capitol Hill about the health care issue at the center of the fight.

The tax breaks that make ACA premiums affordable for many Americans don't expire until December, Republican lawmakers said. But Democratic lawmakers want an extension until enrollment begins Nov. 1, and they have made it a condition of voting to reopen the government.

This is not just a battle over political messages. These are real health insurance markets, where real people – 24 million of which – buy coverage. The amount the federal government collects in monthly insurance premiums matters a lot.

Here are five key facts about this policy.

1. The public supports subsidies

A poll last week found that more than three-quarters of people across the political spectrum favor Congress extending the ACA's expanded tax breaks. The survey was conducted by KFF, a nonpartisan health research organization.

“We found that 78% of the population, including most Democrats, Independents, Republicans and [Make America Great Again] proponents all believe Congress should extend the bonus tax break beyond 2025,” says Ashley Kirzingerdirector of survey methodology at KFF.

Other polls showed similar results: 72% of voters across all political parties supported extending the policy, according to a July poll by Republican pollsters Tony Fabrizio and Bob Ward. They surveyed two dozen competitive congressional districts and found that support for the policy was high even among those who had no personal connection to these health plans.

In the memothey wrote, “Voters don’t want people to lose health insurance.”

2. The question is relevant, since open enrollment will begin soon.

North Dakota Insurance Commissioner John Godfriedsays extended subsidies need to be extended before open registration begins Nov. 1 and calls on lawmakers to “do it now.”

He is his state's elected Republican and President National Association of Insurance CommissionersA member organization of US state insurance regulators. “Red state, blue state, appointed, elected, we have unanimous approval in support of these tax breaks,” he says.

If Congress acts quickly, marketplaces may be able to show subsidized rates to those who walk into the store as soon as open enrollment begins. “Most states, if not all states, had their [insurance] carriers submit two sets of tariffs – one with subsidies, the other without,” he says. “And so if they do a net extension of those subsidies, I think most states would be willing to go for it.”

If Congress misses that deadline, he said, consumers who log in to buy a plan will see much higher premiums and may not return even if Congress ends up extending the credits by the end of December.

3. Next year, premiums will increase sharply.

When insurers set their rates for 2026, they factored in rising health care costs as well as the likelihood that subsidies would expire and push the healthiest people out of ACA markets.

When KFF researchers analyzed insurance claims for 2026, they found that premiums for many consumers would double next year. “On average, we expect member premium payments to increase by 114% if the extended tax credits expire,” says Cynthia Coxdirector of the KFF ACA program.

Sky-high insurance premiums can force people to take risks and remain uninsured, she said. Congressional Budget Office assessments that 4 million people will remain uninsured in the next few years if the expanded tax breaks expire.

4. Most applicants live in states won by Trump.

The people who rely on HealthCare.gov and other Obamacare marketplaces are people who “work in places where they don't have coverage,” KFF's Cox explains. “Often these are small businesses. Or they could be farmers and ranchers. This could be workers such as Uber drivers.”

Geographically, more than 3 in 4 applicants live in states that President Trump won in 2024. according to KFF data. That's partly because some Southern states have seen enrollment surges recently. “Six states (Texas, Louisiana, Mississippi, Tennessee, Georgia and West Virginia) more than tripled their enrollment in five years,” notes Cox's colleague Emma Wager.

5. Subsidies are expensive for the government.

The subsidies that allowed consumers to lower costs cost the federal government a lot of money. The Congressional Budget Office estimates it will cost the government $350 billion over the next decade if the increased subsidies were extended on a permanent basis.

Conservative groups, which have always opposed the Affordable Care Act, oppose increasing subsidies. A coalition of groups recently performed at letter President that the expanded tax breaks were intended to be temporary during the COVID-19 pandemic and that extending them would exacerbate rising health care costs.

“While some Americans may be concerned about rising premiums in the short term, removing the incentive for insurers to continue raising prices will save patients money in the long term,” they wrote.

Other Republicans, such as Rep. Marjorie Taylor Greene of Georgia and Sen. Josh Hawley of Missouri, have said they support extending the tax cuts or developing another plan to prevent steep rate increases for consumers.

Godfried, the Republican insurance commissioner in North Dakota, says the debate over rising health care costs is real and worthwhile, but there is a sense of urgency right now.

“This is a separate discussion,” he asserts. “We can talk about health care costs and pharmaceutical costs and all that stuff, but we still need to get access to consumers, and that's what these subsidies have helped provide.”