Health care compromise appears far off as the government shutdown
stalemate persists
[October 23, 2025]
By MARY CLARE JALONICK
WASHINGTON (AP) — The government shutdown has reopened debate on what
has been a central issue for both major political parties in the last 15
years: the future of health coverage under the Affordable Care Act.
Tax credits for people who get health insurance through the marketplaces
created by the Affordable Care Act, also known as Obamacare, expire at
the end of the year.
Democrats say they won’t vote to reopen the government until Republicans
negotiate an extension of the expanded subsidies. Republicans say they
won’t negotiate until Democrats vote to reopen the government. Lawmakers
in both parties have been working on potential solutions behind the
scenes, hoping that leaders will eventually start to talk, but it’s
unclear if the two sides could find compromise.
As Congress circles the issue, a poll from The Associated Press-NORC
Center for Public Affairs Research found that about 6 in 10 Americans
are “extremely” or “very” concerned about their health costs going up in
the next year. Those worries extend across age groups and include people
with and without health insurance, the poll found.
A look at the subsidies that are expiring, the politics of the ACA and
what Congress might do:
Enhanced premium help during the pandemic
Passed in 2010, the ACA was meant to decrease the number of uninsured
people in the country and make coverage more affordable for those who
don’t have private insurance. The law created state by state exchanges,
some of which are run by the individual states, to try to increase the
pool of the insured and bring down rates.
In 2021, when Democrats controlled Congress and the White House during
the COVID-19 pandemic, they expanded premium help that was already in
the law. The changes included eliminating premiums for some lower-income
enrollees, ensuring that higher earners paid no more than 8.5% of their
income and expanding eligibility for middle-class earners.
The expanded subsidies pushed enrollment to new levels and drove the
rate of uninsured people to a historic low. This year, a record 24
million people have signed up for insurance coverage through the ACA, in
large part because billions of dollars in subsidies have made the plans
more affordable for many people.
If the tax credits expire, annual out-of-pocket premiums are estimated
to increase by 114% — an average of $1,016 — next year, according to an
analysis from KFF.
Democrats push to extend subsidies
Democrats extended those tax credits in 2022 for another three years but
were not able to make them permanent. The credits are set to expire Jan.
1, with Republicans now in full control.
Lacking in power and sensing a political opportunity, Democrats used
some of their only leverage and forced a government shutdown over the
issue when federal funding ran out on Oct. 1. They say they won’t vote
for a House-passed bill to reopen the government until Republicans give
them some certainty that the subsidies will be extended.
Democrats introduced legislation in September to permanently extend the
premium tax credits, but they have suggested that they are open to a
shorter period.
“We need a serious negotiation,” Senate Democratic leader Chuck Schumer
has repeatedly said.
Republicans try to scale the ACA back, again
The Democratic demands on health care have reignited longstanding
Republican complaints about the ACA, which they have campaigned against
for years and tried and failed to repeal in 2017. Many in the party say
that if Congress is going to act, they want to scrap the expanded
subsidies and overhaul the entire law.
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Senate Majority Leader John Thune, of S.D., center, and other
republican Senate members, speak with reporters after a meeting with
President Donald Trump at the White House, Tuesday, Oct. 21, 2025,
in Washington. (AP Photo/Alex Brandon)
The problem is not the expiring subsidies but “the cost of health
care,” Republican Sen. Rick Scott of Florida said Tuesday.
In a virtual briefing Tuesday, the libertarian Cato Institute and
the conservative Paragon Health Institute branded the subsidies as
President Joe Biden’s "COVID credits” and claimed they’ve enabled
fraudsters to sign people up for fully subsidized plans without
their knowledge.
Others have pitched more modest proposals that could potentially win
over some Democrats. Senate Majority Leader John Thune, R-S.D., has
said he is open to extending the subsidies with changes, including
lower income limits and a stop to auto-enrollment that may sign up
people who don’t need the coverage.
The ACA is “in desperate need of reform,” Thune has said.
House Republicans are considering their own ideas for reforming the
ACA, including proposals for phasing out the subsidies for new
enrollees. And they have begun to discuss whether to combine health
care reforms with a new government funding bill and send it to the
Senate for consideration once they return to Washington.
“We will probably negotiate some off-ramp" to ease the transition
back to pre-COVID-19 levels, said Maryland Rep. Andy Harris, the
head of the conservative House Freedom Caucus, during a virtual town
hall Tuesday.
Is compromise possible?
A number of Republicans want to extend the subsidies. Sen. Josh
Hawley, R-Mo., said most people who are using the exchanges created
by the ACA “don’t really have another option, and it’s already
really, really expensive. So I think there are things we can do to
reform the program.”
Hawley said he had been having conversations with other senators
about what those changes could be, including proposals for income
limits, which he said he sees as a “very reasonable.”
Bipartisan groups of lawmakers have been discussing the income
limits and other ideas, including making the lowest-income people
pay very low premiums instead of nothing. Some Republicans have
advocated for that change to ensure that all enrollees are aware
they have coverage and need it. Other proposals would extend the
subsidies for a year or two or slowly phase them out.
It's unclear if any of those ideas could gain traction on both sides
— or any interest from the White House, where President Donald Trump
has remained mostly disengaged. Despite the public stalemate,
though, lawmakers are feeling increased urgency to find a solution
as the Nov. 1 open enrollment date approaches.
Democratic Sen. Jeanne Shaheen of New Hampshire has been talking to
lawmakers since the shutdown began, trying to find areas of
compromise. On Tuesday, she suggested that Congress could also look
at extending the enrollment dates for the ACA since Congress is
stalled on the subsidies.
“These costs are going to affect all of us, and it’s going to affect
our health care system,” she said.
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Associated Press writers Lisa Mascaro and Joey Cappelletti in
Washington and Ali Swenson in New York contributed to this report.
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