Working-class Americans could face significant challenges if the federal government shutdown continues, jeopardizing access to affordable healthcare through the Affordable Care Act.
The Affordable Care Act (ACA), a cornerstone of the American healthcare system for the past 15 years, has provided millions of Americans with access to affordable health coverage. Commonly referred to as Obamacare, the ACA allows individuals to purchase insurance through marketplaces and protects over 100 million people with pre-existing conditions from being denied coverage by insurance companies.
Despite its success, the ACA has faced ongoing opposition from Republican lawmakers. During his first term, former President Trump attempted to weaken or dismantle the ACA through various repeal-and-replace efforts and lawsuits. His administration implemented measures to undermine the law’s effectiveness, including cutting funding for public outreach, limiting enrollment periods, and promoting alternatives that circumvented ACA regulations.
In 2017, the ACA narrowly avoided repeal when the late Senator John McCain cast a pivotal vote against its dismantling. Now, in his second term, Trump has renewed efforts to roll back key provisions of the ACA.
In June 2025, the House of Representatives passed H.R.1, the Budget Reconciliation Act of 2025, also known as the “One Big Beautiful Bill” (OBBB). This legislation introduced significant changes to ACA marketplaces, impacting millions of Americans, including small business owners, self-employed workers, gig economy participants, and hourly wage earners. The OBBB also proposed funding cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
Instead of prioritizing healthcare, the OBBB focused on tax cuts for the wealthy, increased funding for immigration enforcement and defense, and subsidies for fossil fuels. The Congressional Budget Office (CBO) projects that the national debt could increase by $687 billion from 2025 to 2034, pushing the cumulative deficit to approximately $4.5 trillion. Despite these fiscal concerns, Republicans have continued to advocate for their agenda, opting not to extend enhanced ACA tax credits.
The federal government shut down two weeks ago due to a budget impasse between Republicans and Democrats over the future of ACA tax credits, which are set to expire at the end of December 2025. Democratic leaders are advocating for the permanent extension of these tax credits, rejecting temporary solutions that would only delay the issue.
During an October 10 briefing hosted by the American Community Media, health policy experts discussed the implications of the shutdown on ACA operations and enrollment. In 2025, over 24 million people were enrolled through ACA marketplaces, with 90% receiving federal tax credits that significantly reduced their monthly premiums. These enhanced credits, introduced by the Biden administration in 2021, expanded eligibility and increased the value of subsidies. However, the OBBB threatens to undermine these provisions by eliminating automatic re-enrollment for those receiving premium tax credits, shortening the open enrollment period, and removing the repayment cap for enrollees whose income changes during the year.
As a result, the accessibility and stability of ACA coverage could be severely compromised.
Anthony Wright, Executive Director at Families USA, emphasized that roughly half of the American population receives insurance coverage through their employers, while public programs like Medicaid and Medicare cover one-quarter to one-third of Americans. The remaining individuals and families rely on ACA marketplaces for their healthcare needs. Wright warned that Congress must act before November 1, when the next open enrollment period begins, to renew enhanced tax credits. If they fail to do so, insurance premiums are expected to rise dramatically, making coverage unaffordable for many.
Wright stated, “The Congressional Budget Office estimates that 1.5 million people may opt not to get coverage, just from the sticker shock, when they see what the new premiums are going to be!” If Congress does not take action, potential enrollees will encounter higher premiums, which may discourage them from signing up, even if lawmakers later restore the credits before the year ends.
The nonpartisan Kaiser Family Foundation (KFF) estimates that if these tax credits expire, average premiums could increase by 114% or even double for some individuals in 2026. This could lead to at least 4 million people becoming uninsured in the coming years, according to the Congressional Budget Office.
Jenny Sullivan of the Center for Budget and Policy Priorities noted that 93% of marketplace enrollees currently receive premium tax credits (PTCs). The enhanced tax credits, initially introduced during the COVID-19 pandemic under the American Rescue Plan Act and later extended by the Inflation Reduction Act, have reduced average premiums by 44%. This reduction has led to a significant increase in enrollment, particularly among historically uninsured groups, including Black and Latino communities, low-income individuals, and residents of states that opted not to expand Medicaid. In these states, enhanced tax credits often represent the only path to affordable coverage.
Importantly, about 90% of marketplace enrollees earn below the threshold for premium tax credits, with nearly half earning less than twice the federal poverty level. This underscores the ACA’s critical role in supporting working-class Americans.
Data from KFF shows that 75% of enrollees who rely on HealthCare.gov or ACA marketplaces reside in states that Trump won in 2024. The ACA was designed with a dual system—Medicaid for the poorest and subsidies for those with slightly higher incomes. However, many low-income residents in states that declined to expand Medicaid rely solely on marketplace subsidies for healthcare access, resulting in disproportionately high enrollment in states like Tennessee, Georgia, Mississippi, Louisiana, West Virginia, and Texas. Enrollment in these red states has tripled since the ACA’s inception, with only West Virginia and Louisiana opting to expand Medicaid.
Public sentiment appears to favor the extension of tax credits. A KFF poll revealed that 78% of Americans support continuing premium tax credits beyond 2025. Support spans across party lines, with 92% of Democrats, 82% of Independents, and 59% of Republicans in favor of this extension. Even among self-identified MAGA supporters, 57% agree that these subsidies should continue.
This widespread public support has prompted some Republicans facing challenging reelection races to reconsider their positions. In September 2025, 11 GOP House members endorsed H.R. 5145, a bipartisan proposal to extend the subsidies through 2026, effectively postponing the issue until after the midterm elections. However, the bill has yet to be brought to a vote. GOP leader Marjorie Taylor Greene of Georgia publicly expressed her support for the extension, stating, “I’m absolutely disgusted that health insurance premiums will DOUBLE if the tax credits expire this year.”
Looking ahead, without congressional action before November 1, millions could face unaffordable premium hikes during the open enrollment period, jeopardizing the coverage gains achieved over the past decade.
Advocates at the briefing urged citizens, advocacy groups, and healthcare organizations to contact their representatives, raise public awareness, and participate in outreach campaigns that highlight the human and economic costs of allowing tax credits to lapse. They called on policymakers to weigh short-term fiscal arguments against the long-term social and economic stability that universal, affordable healthcare can provide.
The Affordable Care Act is not merely a landmark healthcare reform; it serves as a barometer of political will and compassion in the United States, determining whether access to healthcare is regarded as a privilege or a right.
Source: Original article
