things to know about the health care fight behind the shutdown.
October 12, 20257:02 AM ET
Heard on Weekend Edition Sunday
By Selena Simmons-Duffin/NPR
Democrats say extending the Affordable Care Act tax credits is urgent. Republicans say there's plenty of time to figure it out.
As the government shutdown goes on, there are a lot of mixed messages on Capitol Hill about the health care issue at the center of the fight.
The tax credits that make ACA health care premiums affordable for many Americans don't expire until December, as Republican lawmakers note. But Democratic lawmakers want to see them extended before enrollment begins Nov. 1, and they have made that a condition of voting to reopen the government.
It's not just a battle over political messaging. These are real health insurance marketplaces where real people — 24 million of them — buy coverage. The amount the federal government picks up for their monthly premiums makes a big difference.
Here are five key facts about the policy.
1. The public supports the subsidies
A poll last week found that more than three-quarters of people across the political spectrum are in favor of Congress extending the enhanced ACA tax credits. The poll was conducted by KFF, the nonpartisan health research organization.
"What we found is 78% of the public — including majorities of Democrats, independents, Republicans and [Make America Great Again] supporters — all think Congress should extend the premium tax credits beyond 2025," says Ashley Kirzinger, KFF's director of survey methodology.
Other polls have had similar findings: 72% of voters across political parties supported extending the policy, according to a July survey 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 for those who had no personal connection to these health plans.
In a memo, they wrote: "Voters don't want to see people losing their health insurance."
2. The issue is urgent since open enrollment starts soon
North Dakota's insurance commissioner, Jon Godfread, says the enhanced subsidies need to be extended before open enrollment starts Nov. 1, calling on lawmakers to "do this now."
He's an elected Republican in his state and the president of the National Association of Insurance Commissioners, a membership organization of state insurance regulators across the United States. "Red state, blue state, appointed, elected — we have unanimous approval supporting these tax credits," he says.
If Congress acts quickly, the marketplaces could possibly show the subsidized rates to those who log in to shop as soon as open enrollment begins. "Most states, if not all states, had their [insurance] carriers file two sets of rates — one with subsidies, one without," he says. "And so if they do a clean extension of these subsidies, I think most states will be ready to go on that."
If Congress misses that deadline, he says, consumers who log in to shop for a plan will see much higher premiums and they may not come back, even if Congress ultimately extends the credits by the end of December.
3. Premiums are set to shoot up next year
When health insurers were setting their rates for 2026, they factored in the rising cost of health care, plus the possibility that the subsidies would expire and drive the healthiest people out of the ACA marketplaces.
When researchers at KFF analyzed 2026 insurance filings, they found that premiums will double for many consumers next year. "On average, we're expecting premium payments by enrollees to increase by 114% if these enhanced tax credits expire," says Cynthia Cox, director of the Program on the ACA at KFF.
Sky-high premiums might drive people to risk it and go uninsured, she says. The Congressional Budget Office estimates that 4 million people will become uninsured in the next few years if the enhanced tax credits expire.
4. Most enrollees live in states that Trump won
The people who rely on HealthCare.gov and the other Obamacare marketplaces are people who "work at a place that doesn't offer them coverage," explains Cox, of KFF. "A lot of times, that's a small business. Or it could be farmers and ranchers. It could be gig workers like Uber drivers."
Geographically, more than 3 in 4 enrollees live in states that President Trump won in 2024, according to KFF. Part of that is due to the fact that some Southern states have seen dramatic growth in enrollment recently. "In six states (Texas, Louisiana, Mississippi, Tennessee, Georgia and West Virginia), enrollment has more than tripled in five years," notes Cox's colleague Emma Wager.
5. The subsidies are expensive for the government
The subsidies that kept costs down for consumers cost the federal government a lot of money. The Congressional Budget Office estimates it would cost the government $350 billion over the next decade if the enhanced subsidies were extended permanently.
Conservative groups that have always opposed the Affordable Care Act are against the enhanced subsidies. A coalition of groups recently argued in a letter to the president that the enhanced tax credits were meant to be temporary during the COVID-19 pandemic and that extending them will exacerbate rising health care costs.
"While some Americans may be concerned about premiums going up in the short term, removing the incentive for insurers to continue raising their prices will save patients money in the long run," they write.
Other Republicans — like Rep. Marjorie Taylor Greene of Georgia and Sen. Josh Hawley of Missouri — have said they support extending the tax credits or coming up with a different plan to prevent dramatic rate hikes for consumers.
Godfread, the Republican insurance commissioner of North Dakota, says that the debate over rising health costs is real and worthwhile, but there's urgency in this moment.
"That discussion is separate," he argues. "We can talk about the costs of health care and pharmaceuticals, all the pieces — but we've still got to get access to consumers and that's what these subsidies have helped provide."
Heard on Weekend Edition Sunday
By Selena Simmons-Duffin/NPR
Democrats say extending the Affordable Care Act tax credits is urgent. Republicans say there's plenty of time to figure it out.
As the government shutdown goes on, there are a lot of mixed messages on Capitol Hill about the health care issue at the center of the fight.
The tax credits that make ACA health care premiums affordable for many Americans don't expire until December, as Republican lawmakers note. But Democratic lawmakers want to see them extended before enrollment begins Nov. 1, and they have made that a condition of voting to reopen the government.
It's not just a battle over political messaging. These are real health insurance marketplaces where real people — 24 million of them — buy coverage. The amount the federal government picks up for their monthly premiums makes a big difference.
Here are five key facts about the policy.
1. The public supports the subsidies
A poll last week found that more than three-quarters of people across the political spectrum are in favor of Congress extending the enhanced ACA tax credits. The poll was conducted by KFF, the nonpartisan health research organization.
"What we found is 78% of the public — including majorities of Democrats, independents, Republicans and [Make America Great Again] supporters — all think Congress should extend the premium tax credits beyond 2025," says Ashley Kirzinger, KFF's director of survey methodology.
Other polls have had similar findings: 72% of voters across political parties supported extending the policy, according to a July survey 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 for those who had no personal connection to these health plans.
In a memo, they wrote: "Voters don't want to see people losing their health insurance."
2. The issue is urgent since open enrollment starts soon
North Dakota's insurance commissioner, Jon Godfread, says the enhanced subsidies need to be extended before open enrollment starts Nov. 1, calling on lawmakers to "do this now."
He's an elected Republican in his state and the president of the National Association of Insurance Commissioners, a membership organization of state insurance regulators across the United States. "Red state, blue state, appointed, elected — we have unanimous approval supporting these tax credits," he says.
If Congress acts quickly, the marketplaces could possibly show the subsidized rates to those who log in to shop as soon as open enrollment begins. "Most states, if not all states, had their [insurance] carriers file two sets of rates — one with subsidies, one without," he says. "And so if they do a clean extension of these subsidies, I think most states will be ready to go on that."
If Congress misses that deadline, he says, consumers who log in to shop for a plan will see much higher premiums and they may not come back, even if Congress ultimately extends the credits by the end of December.
3. Premiums are set to shoot up next year
When health insurers were setting their rates for 2026, they factored in the rising cost of health care, plus the possibility that the subsidies would expire and drive the healthiest people out of the ACA marketplaces.
When researchers at KFF analyzed 2026 insurance filings, they found that premiums will double for many consumers next year. "On average, we're expecting premium payments by enrollees to increase by 114% if these enhanced tax credits expire," says Cynthia Cox, director of the Program on the ACA at KFF.
Sky-high premiums might drive people to risk it and go uninsured, she says. The Congressional Budget Office estimates that 4 million people will become uninsured in the next few years if the enhanced tax credits expire.
4. Most enrollees live in states that Trump won
The people who rely on HealthCare.gov and the other Obamacare marketplaces are people who "work at a place that doesn't offer them coverage," explains Cox, of KFF. "A lot of times, that's a small business. Or it could be farmers and ranchers. It could be gig workers like Uber drivers."
Geographically, more than 3 in 4 enrollees live in states that President Trump won in 2024, according to KFF. Part of that is due to the fact that some Southern states have seen dramatic growth in enrollment recently. "In six states (Texas, Louisiana, Mississippi, Tennessee, Georgia and West Virginia), enrollment has more than tripled in five years," notes Cox's colleague Emma Wager.
5. The subsidies are expensive for the government
The subsidies that kept costs down for consumers cost the federal government a lot of money. The Congressional Budget Office estimates it would cost the government $350 billion over the next decade if the enhanced subsidies were extended permanently.
Conservative groups that have always opposed the Affordable Care Act are against the enhanced subsidies. A coalition of groups recently argued in a letter to the president that the enhanced tax credits were meant to be temporary during the COVID-19 pandemic and that extending them will exacerbate rising health care costs.
"While some Americans may be concerned about premiums going up in the short term, removing the incentive for insurers to continue raising their prices will save patients money in the long run," they write.
Other Republicans — like Rep. Marjorie Taylor Greene of Georgia and Sen. Josh Hawley of Missouri — have said they support extending the tax credits or coming up with a different plan to prevent dramatic rate hikes for consumers.
Godfread, the Republican insurance commissioner of North Dakota, says that the debate over rising health costs is real and worthwhile, but there's urgency in this moment.
"That discussion is separate," he argues. "We can talk about the costs of health care and pharmaceuticals, all the pieces — but we've still got to get access to consumers and that's what these subsidies have helped provide."
