If the Government Shuts Down, Obamacare Will Be Why

ANOTHER GOVERNMENT SHUTDOWN could be weeks away. And it looks like a central issue—maybe the central issue—will be whether lawmakers can agree on extending some temporary Affordable Care Act subsidies that are currently bringing down the price of health insurance for more than 20 million Americans.

But the divides here aren’t just between the parties. They’re also within the parties, over what their goals should be—and how to achieve them.

The Democrats’ divide is primarily strategic. Using government money to help people pay for health care is in their party’s DNA. 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.

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 extension or settle for a temporary one? Do they make subsidies their only demand or add reversal of the Republicans’ recently enacted Medicaid cuts—and maybe throw in some demands that have nothing to do with health care per se?

On the Republican side, the debate has a more substantive component, because they can’t even agree on what they want. They know letting the subsidies lapse would mean higher costs and more people dropping coverage—and that a lot of those affected would be in divided, vulnerable districts or states Democrats could win in the midterms.

But these are Republicans and conservatives who generally don’t want to spend government money on health care—and who definitely don’t want to spend government money on “Obamacare.” They say it’s bad for health care and bad for the economy, especially given that the money ultimately comes from taxpayers.

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

Share

The tweet was notable because Slotkin is from Michigan, a key swing state, and because she’s always presented herself as ideologically moderate—at least within the Democratic party—and as somebody who tries to work with Republicans. The fact that she’d stake out such an aggressive position says a lot about the party’s confidence that a fight on health care is worth having—and winnable.¹

But if Democrats seem united in their conviction they should make a stand on health care, they haven’t 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, Ezra Klein, and Josh Marshall, who think the party should be asking for a lot more—and not just on health care.

Still, the divide inside the GOP is even more visible—and maybe more fluid.

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

But Trump hasn’t said a word so far, while conservative Republicans have made clear they want no part of an extension. “My take is hell no,” Rep. Eric Burlison, a Missouri Republican, told NOTUS. “At some point, we need to be an adult and say this nation can’t afford it.”

And that was before Tuesday, when an evidently less amenable Thune told Bloomberg that he was a firm “no” on including a subsidy extension in the government-funding bill.

That’s a pretty wide spectrum of opinion—both substantively and strategically—with a lot of uncertainty built into the political environment.

“As we start to see the premium increases rack up, we’re seeing more Democratic resolve and more Republican interest in extending the credits,” Anthony Wright, executive director of the advocacy group Families USA, told me this week. “But there’s 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’s a much more complicated task.”

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?

TO ANSWER THESE QUESTIONS, it helps to remember how the Affordable Care Act works—and why these subsidies that affect so many people are now in