{"id":135714,"date":"2025-09-11T08:30:19","date_gmt":"2025-09-11T08:30:19","guid":{"rendered":"https:\/\/www.newsbeep.com\/ca\/135714\/"},"modified":"2025-09-11T08:30:19","modified_gmt":"2025-09-11T08:30:19","slug":"if-the-government-shuts-down-obamacare-will-be-why","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ca\/135714\/","title":{"rendered":"If the Government Shuts Down, Obamacare Will Be Why"},"content":{"rendered":"

\"\"<\/a>(Composite \/ Photos: Shutterstock)<\/p>\n

ANOTHER GOVERNMENT SHUTDOWN could be weeks away. And it looks like a central issue\u2014maybe the central issue\u2014will be whether lawmakers can agree on extending some temporary Affordable Care Act subsidies<\/a> that are currently bringing down the price of health insurance for more than 20 million Americans.<\/p>\n

But the divides here aren\u2019t just between the parties. They\u2019re also within the parties, over what their goals should be\u2014and how to achieve them.<\/p>\n

The Democrats\u2019 divide is primarily strategic. Using government money to help people pay for health care is in their party\u2019s DNA<\/a>. And they know that if the subsidies lapse at the end of this year, when their current authorization runs out, millions will have to pay more for their insurance, forcing some to drop coverage altogether.<\/p>\n

Where Democrats disagree is over how to use what leverage they have, as a supplier of congressional votes GOP leaders will need to keep the government open when funding runs out on September 30. Do they insist on a permanent<\/a> extension or settle for a temporary<\/a> one? Do they make subsidies their only demand or add reversal of the Republicans\u2019 recently enacted Medicaid cuts<\/a>\u2014and maybe throw in some demands that have nothing to do with health care per se<\/a>?<\/p>\n

On the Republican side, the debate has a more substantive component, because they can\u2019t even agree on what they want. They know letting the subsidies lapse would mean higher costs and more people dropping coverage\u2014and that a lot of those affected would be in divided, vulnerable districts or states Democrats could win in the midterms.<\/p>\n

But these are Republicans and conservatives who generally don\u2019t want to spend government money on health care\u2014and who definitely don\u2019t want to spend government money on \u201cObamacare.\u201d They say it\u2019s bad for health care and bad for the economy, especially given that the money ultimately comes from taxpayers.<\/p>\n

Both sides are staking out positions now, in ways that will determine how the debate plays out\u2014and, inevitably, whether the government is still open come October 1. Just this week, Democratic Senator Elissa Slotkin tweeted<\/a> that Trump and Republicans have to \u201cwalk back cuts to health care\u201d if they expect her support on a government-funding bill.<\/p>\n

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The tweet was notable because Slotkin is from Michigan, a key swing state, and because she\u2019s always presented herself as ideologically moderate\u2014at least within the Democratic party\u2014and as somebody who tries to work with Republicans. The fact that she\u2019d stake out such an aggressive position says a lot about the party\u2019s confidence that a fight on health care is worth having\u2014and winnable.<\/p>\n

But if Democrats seem united in their conviction they should make a stand on health care, they haven\u2019t settled what that stand should look like. Already there seems to be a divide between Democratic leaders in Congress, who have been hinting they think getting a temporary extension of the subsidies would qualify as a big win, and influential outside commentators like David Dayen<\/a>, Ezra Klein<\/a>, and Josh Marshall<\/a>, who think the party should be asking for a lot more\u2014and not just on health care.<\/p>\n

Still, the divide inside the GOP<\/a> is even more visible\u2014and maybe more fluid.<\/p>\n

Ten House Republicans have introduced a bill<\/a> to extend subsidies for one year. Both House Speaker Mike Johnson and Senate Majority Leader John Thune have, at different times, indicated<\/a> they might be open to some kind of extension. And Trump\u2019s own advisers keep warning<\/a> that letting the subsidies lapse could put the GOP\u2019s congressional majorities in jeopardy.<\/p>\n

But Trump hasn\u2019t said a word so far, while conservative Republicans have made clear they want no part<\/a> of an extension. \u201cMy take is hell no,\u201d Rep. Eric Burlison, a Missouri Republican, told NOTUS<\/a>. \u201cAt some point, we need to be an adult and say this nation can\u2019t afford it.\u201d<\/p>\n

And that was before Tuesday, when an evidently less amenable Thune told Bloomberg<\/a> that he was a firm \u201cno\u201d on including a subsidy extension in the government-funding bill.<\/p>\n

That\u2019s a pretty wide spectrum of opinion<\/a>\u2014both substantively and strategically\u2014with a lot of uncertainty built into the political environment.<\/p>\n

\u201cAs we start to see the premium increases rack up, we\u2019re seeing more Democratic resolve and more Republican interest in extending the credits,\u201d Anthony Wright<\/a>, executive director of the advocacy group Families USA, told me this week. \u201cBut there\u2019s a very short time window. And they had every opportunity to do this when they passed their reconciliation bill this summer. . . . So now they have this one last chance to rectify this, and it\u2019s a much more complicated task.\u201d<\/p>\n

Underlying all of these decisions are key policy questions: What would it really look like if the temporary subsidies went away? What would it mean to the people who have to pay the new prices?<\/p>\n

TO ANSWER THESE QUESTIONS, it helps to remember how the Affordable Care Act works\u2014and why these subsidies that affect so many people are now in play.<\/p>\n

People who buy health insurance on their own through HealthCare.gov<\/a> or state-run equivalents are eligible for financial assistance that reduces the price of their coverage. The assistance, which is based on incomes, is a big part of how the Affordable Care Act works.<\/p>\n

In 2021, President Joe Biden and the Democrats temporarily increased these subsidies in an effort to improve health care access during the pandemic. But many also saw it as a way to help fulfill the program\u2019s original promise, because the political deals necessary to pass Obamacare<\/a> in 2010 required settling for lower funding\u2014which, in turn, raised premiums or out-of-pocket costs or both for people buying Obamacare coverage.<\/p>\n

Boosting the subsidies in 2021 had a clear effect, as enrollment in the Affordable Care Act marketplaces soared to record levels. And the numbers didn\u2019t capture the full impact. Some people already buying insurance effectively pocketed the extra assistance as savings. Others \u201cbought up\u201d to coverage with lower copays or deductibles.<\/p>\n

But the boost expires at the end of December because Democratic leaders couldn\u2019t get the votes to pay for a permanent extension. And if the extra money goes away, the system will basically snap back to what it was before. Premiums would rise by an average of 75 percent<\/a>, according to<\/a> the health policy research organization KFF. In some cases, people would end up paying thousands or even many thousands of dollars more for insurance every year.<\/p>\n

In real-world terms<\/a>, that would mean people paying more for the same policies or switching to less-generous plans\u2014or dropping coverage altogether, which is what the Congressional Budget Office<\/a> expects about 4 million people to do.<\/p>\n

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It\u2019s worth noting that the people most likely to drop insurance will tend to be healthier, overall, because they are the ones more willing to take their chances with no coverage. Insurance companies have to plan for this and anticipate higher medical expenses for the people they are still insuring. That is why insurers are planning to raise underlying premiums by more than 20 percent this fall\u2014again, based on a KFF analysis<\/a>.<\/p>\n

Because of the way the Affordable Care Act subsidies work\u2014they scale up or down, depending on the price of coverage in a given region\u2014the premium rise itself wouldn\u2019t affect most people directly. But there\u2019s an exception.<\/p>\n

Originally, subsidies were not available to people with incomes above four times the poverty rate, which for an individual works out to about $63,000 in annual income right now. For a family of four, it\u2019s about $129,000. The extra subsidies that Biden and the Democrats enacted in 2021 eliminated the cutoff point, so that even people making incomes above that level got some help.<\/p>\n

They\u2019ll lose that help if the extra subsidies lapse, meaning once again they would have to pay the full price of premiums<\/p>\n

\u201cWhile allowing the ACA enhanced tax credits to lapse would be a return to the previous [pre-2021] status quo,\u201d as Larry Levitt<\/a>, KFF\u2019s executive vice president for health policy, put it to me, \u201cit would still be a shock to the system.\u201d<\/p>\n

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THAT\u2019S A LOT OF POLICY TO DIGEST, I know, and a lot of mind-numbing numbers. To get a better sense of what this might look like in real life, I reached out to a true expert on the subject: a well-respected health policy analyst who also has a firsthand perspective, because he and his family get their insurance through HealthCare.gov.<\/p>\n

His name is Charles Gaba<\/a>. He was a relatively anonymous web developer until late 2013, when for a few brief months the focus of American politics was the chaotic opening of the Affordable Care Act\u2019s marketplaces. The insurance websites<\/a> weren\u2019t working, while insurers were canceling<\/a> old plans to replace them with newer, frequently more expensive policies that complied with the law.<\/p>\n

With enrollment lagging way behind projections and longtime Obamacare critics saying the debacle proved the law was hopelessly flawed, Gaba took it upon himself<\/a> to start tracking and publicizing enrollment. He wanted to show that the numbers would come up and that lots of people were going to get insurance or save money as a result.<\/p>\n

Events vindicated his prediction, as he became a trusted national source<\/a> on all things related to the Affordable Care Act. He turned the gig into a full-time job as a health policy analyst, advocate, and blogger, which remains his business<\/a> today.<\/p>\n

On Tuesday, I asked Gaba how bad these premium increases might be for certain people. He gave me four examples from Michigan\u2014which is where he lives, as do I\u2014using as his case study the standard plan in Lansing<\/a>:<\/p>\n

A single individual, 50 years old and making $40,000 a year: Right now that person pays $154 a month in premiums. If the extra assistance lapses, they\u2019ll have to pay $298 a month.<\/p>\n

A single parent making $60,000 a year: Right now that person pays $273 a month in premiums. If the extra assistance lapses, they\u2019ll have to pay $489 a month.<\/p>\n

A family of four making $70,000 a year: Right now they pay $146 a month in premiums. If the extra assistance lapses, they\u2019ll have to pay $436 a month.<\/p>\n

A couple, both 64 years old, making $90,000 a year. Right now they pay $638 a month in premiums. If the extra assistance lapses, they\u2019ll have to pay $2,628 a month.<\/p>\n

Yes, that last calculation works out to about an extra $24,000 a year. It\u2019s an extreme case, because of how the ACA subsidy formula works. But for low-income people, even a small bump in premiums can be difficult. And it\u2019s not like middle-income people get off easy, as Gaba himself can attest.<\/p>\n

\u201cAs far as I can tell, we\u2019re probably looking at getting hit for at least $6,000 more per year if we stayed on the same plan\u2014which, all else being equal, we cannot afford,\u201d Gaba said. \u201cAnd we\u2019re a middle-class family, we\u2019re actually in a relatively good position. There are going to be millions of people who are going to be in a far worse position.\u201d<\/p>\n

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IN SOME WAYS, allowing the extra assistance to lapse would bring about a reprise of the political nightmare Obama and the Democrats faced in late 2013 and early 2014. People were furious that insurers were canceling old policies\u2014and charging higher prices for new ones\u2014in order to comply with new federal rules.<\/p>\n

But the Affordable Care Act\u2019s champions could claim, plausibly, that lots of people were either saving money because of the new financial assistance or getting insurance for the first time. They could also say that among those who were paying more, most were getting insurance with better protection against serious medical costs.<\/p>\n

In short, there were plenty of clear \u201cwinners,\u201d while even the \u201closers\u201d were getting some benefit. And the addition of those extra subsidies since 2021 means there are even more winners than before.<\/p>\n

That doesn\u2019t mean the benefits come without tradeoffs. If the extra subsidies go away, the government will spend less money\u2014between $30 and $40 billion less per year. And eventually those savings will find their way back to the taxpayers in some form or maybe reduce the deficit. That\u2019s a lot of upside for anybody who thinks reducing government spending should be a top priority, as lots of Republicans (and plenty of non-Republicans) do.<\/p>\n

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But it\u2019s hard to think of anybody who would end up with cheaper insurance or better coverage. You can check for yourself in the state estimates<\/a> on Gaba\u2019s site\u2014the scariest numbers may be in West Virginia<\/a>\u2014or by using an interactive calculator<\/a> on the KFF site that will let you plug in your zip code, age, and income. They have some different assumptions baked in, but the fundamental tradeoff in both is the same:<\/p>\n

\u201cEveryone buying coverage in the ACA marketplaces will be worse off if the enhanced tax credits are allowed to expire,\u201d Levitt said. \u201cGovernment costs will be lower, but people\u2019s health care costs will be higher.\u201d<\/p>\n

That\u2019s the foundation for a big political backlash, one that might come disproportionately from Republican districts and states\u2014and some key GOP constituencies too.<\/p>\n

\u201cMany of [those affected] are going to be working-class people, at a time when Republicans are now claiming to be the working-class party, because they are the ones who work at jobs that don\u2019t provide health care,\u201d Wright noted.<\/p>\n

The question now is whether that\u2019s enough to motivate some kind of policy change. With the government-shutdown fight just days away\u2014and with the subsidies ending in just a few weeks\u2014the time for that to happen is running out fast.<\/p>\n

Leave a comment<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"(Composite \/ Photos: Shutterstock) ANOTHER GOVERNMENT SHUTDOWN could be weeks away. And it looks like a central issue\u2014maybe…\n","protected":false},"author":2,"featured_media":135715,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[49,48,84,392],"class_list":{"0":"post-135714","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-ca","9":"tag-canada","10":"tag-health","11":"tag-healthcare"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/135714","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=135714"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/135714\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/135715"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=135714"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=135714"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=135714"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}