ACA health care plans at center of shutdown fight: NPR

Democrats say there’s an urgent need to expand the Affordable Care Act’s tax credits. Republicans say they have plenty of time to figure it out.

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

The tax credits that make ACA health care premiums affordable for many Americans don’t expire until December, Republican lawmakers note. But Democratic lawmakers want to see them extended before registration begins on November 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 marketplaces where real people – 24 million of them – buy coverage. How much the federal government charges for monthly premiums makes a big difference.

Here are five key facts about politics.

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 enhanced tax credits. The poll was conducted by KFF, the nonpartisan health research organization.

“What we found is that 78% of the public — including majorities of Democrats, independents, Republicans and (Make America Great Again) supporters — all think Congress should extend premium tax credits beyond 2025,” said Ashley Kirzinger, KFF’s director of survey methodology.

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

In a memo, they wrote, “Voters don’t want to see people lose their health insurance.”

2. The question is urgent since open registrations start soon

North Dakota Insurance Commissioner Jon Godfread said the enhanced subsidies must be extended before open enrollment begins Nov. 1, calling on lawmakers to “do it now.”

He is an elected Republican in his state and president of the National Association of Insurance Commissioners, an organization of state insurance regulators across the United States. “Red state, blue state, appointed, elected — we have unanimous approval of these tax credits,” he says.

If Congress acts quickly, marketplaces could potentially display subsidized prices to those who go online to shop as soon as open enrollment begins. “Most, if not all, states have required their insurance companies to file two sets of rates — one with subsidies, one without,” he says. “And so if they cleanly expand those grants, I think most states will be willing to do that.”

If Congress doesn’t meet that deadline, he says, consumers who go online to buy a plan will see much higher premiums and may not return, even if Congress ultimately extends the credits by the end of December.

3. Premiums expected to increase significantly next year

When health insurers set their rates for 2026, they took into account the rising cost of health care, as well as the possibility that subsidies would expire and drive the healthiest people out of the ACA’s markets.

When KFF researchers analyzed insurance records from 2026, they found that premiums would double for many consumers next year. “On average, we expect premiums paid by enrollees to increase by 114% if these enhanced tax credits expire,” says Cynthia Cox, ACA program director at KFF.

Exorbitant premiums could encourage people to take risks and become uninsured, she said. The Congressional Budget Office estimates that 4 million people will become uninsured in the coming years if the enhanced tax credits expire.

4. Most registrants live in states won by Trump

The people who rely on HealthCare.gov and other Obamacare marketplaces are people who “work in a place that doesn’t offer them coverage,” says KFF’s Cox. “Often it’s a small business. Or it might be farmers and ranchers. It might be gig workers like Uber drivers.”

Geographically, more than three in four registrants live in states won by President Trump in 2024, according to KFF. This is partly because some Southern states have recently experienced dramatic enrollment growth. “In six states (Texas, Louisiana, Mississippi, Tennessee, Georgia and West Virginia), enrollment has more than tripled in five years,” notes Cox colleague Emma Wager.

5. Subsidies are expensive for the government

The subsidies that kept costs low for consumers cost the federal government dearly. 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 historically opposed the Affordable Care Act are against increasing 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 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 write.

Other Republicans — like Rep. Marjorie Taylor Greene of Georgia and Sen. Josh Hawley of Missouri — have said they favor extending the tax credits or developing a different plan to prevent dramatic rate hikes for consumers.

Godfread, North Dakota’s Republican insurance commissioner, says the debate over rising health care costs is real and useful, but there’s urgency right now.

“This discussion is separate,” he says. “We can talk about the costs of health care and pharmaceuticals all together, but we still need to have access to consumers and that’s what these grants have helped provide.”