Shutdown showdown: The health care fight giving US a migraine

Here is a look at what's driving a clash that is proving a bitter pill for Americans to swallow.  

- Why is Washington shut down? -

Congress failed to pass a bill to keep federal departments and agencies funded and functioning past October 1, triggering a shutdown. The sticking point? Health care.

Democrats are demanding an extension of subsidies for Affordable Care Act (ACA) plans -- financial aid that keeps premiums affordable for millions.

Republicans -- who run Congress and the White House but need Democratic votes to set budgets -- say that debate should happen later, not as part of a must-pass funding bill.

Both sides have repeatedly blocked the other's reopening proposals in the Senate, meaning federal agencies have been closing and placing some 750,000 nonessential workers on enforced leave, while essential employees have been working without pay. 

- What are these subsidies about? -

The subsidies are enhanced tax credits for people who buy insurance through the ACA -- or "Obamacare" -- marketplace. They were boosted during the Covid-19 pandemic but are set to expire at the end of the year.

If Congress does not act, premiums could rise by an average of 114 percent in 2026 for 24 million Americans who rely on Obamacare, according to health care policy research group KFF. 

That means someone paying the 2025 average of $888 would suddenly owe $1,904 in 2026. The Congressional Budget Office estimates four million people could lose coverage altogether. 

Democrats say letting the subsidies expire would be a disaster for working families, especially in rural areas and Republican-voting states like Texas and Florida, where Obamacare enrollment is highest.

- Why are Republicans saying no? -

Republican leaders argue that health care policy should be debated separately from government funding. They have proposed a "clean" bill with no strings attached to keep the lights on through November 21.

But there is division within the party, with moderates supporting extending the subsidies and hardline conservatives pushing for an end to "Covid-era handouts."

Even Georgia congresswoman and staunch conservative Marjorie Taylor Greene broke ranks, saying she is "disgusted" that premiums could double for her own grown-up children.

- How does this tie into Obamacare? -

The ACA has been a political battleground since it passed in 2010. Republicans have tried for years to dismantle it, while Democrats have fought to protect and expand it.

In this latest chapter of the battle, Democrats want to make the enhanced subsidies permanent, framing it as a defense of affordable health care. Republicans see the shutdown as a chance to revisit the ACA and push for reforms -- or rollbacks.

Some Republicans are also pushing for restrictions on subsidies going to insurers that cover abortion, adding another layer of controversy.

- What is each side telling voters? -

Democrats say Republicans are risking the health of millions by refusing to extend ACA subsidies. Their message: "Protect working families. Extend the subsidies. Reopen the government."

Republicans say Democrats are holding the government hostage over unrelated demands. Their message: "Pass a clean bill. Debate health care later."

Trump and his allies have added to the noise by pushing misleading claims that Democrats want to give free health care to undocumented immigrants.

US law bars such migrants from receiving the health care benefits under debate, and the Democrats have not called for a new act of Congress to change that.

Polls show most Americans side with Democrats on the health care issue. A recent KFF survey found 78 percent support extending the subsidies, including 59 percent of Republicans.

ft/aha