On September 19, 2025, Rep. Adam Smith (D-WA) appeared on Newsmax TV’s “American Agenda” to address a subject that has become a flashpoint in the ongoing debate over government funding and the future of American healthcare. With the threat of a government shutdown looming, Democrats have pushed for healthcare subsidies to be included in a continuing resolution (CR) designed to keep federal operations running. But as the negotiations intensify, questions about who these subsidies are intended for—and how much they will cost—have taken center stage in the national conversation.
During the broadcast, co-host Katrina Szish pressed Smith on a matter that has fueled heated discussions in recent months: whether the proposed subsidies would cover people in the country illegally or those who became eligible for government assistance during the COVID-19 pandemic. The question gets right to the heart of a wider debate about the scope and fairness of federal healthcare aid, especially in a period marked by economic uncertainty and political division.
Smith did not shy away from the issue. “Sure. Two points: One, it’s not $1.4 trillion. I don’t know where Speaker Johnson (R-LA) got that figure. All we’re asking for in the short term CR is this tax credit, which is not $1.4 trillion,” he clarified, directly addressing claims about the subsidy’s cost that have circulated among critics. According to Smith, the actual request is far more modest than some have suggested—a point he emphasized repeatedly throughout the interview.
But beyond the numbers, Smith focused on the fundamental purpose of the subsidy: to help people buy health care. “Yes, this is a subsidy to help people buy health care. It’s not free. It doesn’t give them the health care for nothing. They still have to pay for it. But the subsidy enables them to be able to pay for it, given their economic limitations, and it gets them covered,” Smith explained. The distinction, he argued, is crucial—these are not handouts, but targeted support for individuals who might otherwise fall through the cracks.
The conversation then shifted to the broader impact of uninsured Americans on the healthcare system. Smith was unequivocal: “And the thing people need to understand, if people are uninsured, this is a burden on the whole healthcare system. They still get health care, to some degree, but it’s uncompensated care. This is why you see rural hospitals and community healthcare clinics in poorer communities shutting down because they’re no longer getting paid for the health care that they were going to provide. So health care is an enormous issue, and it’s a subsidy to help people buy health insurance.”
Smith’s comments echoed a growing concern among healthcare professionals and policy experts. According to multiple reports, the closure of rural hospitals and community clinics has accelerated in recent years, particularly in areas with high numbers of uninsured residents. When patients cannot pay for care—and when there is no reimbursement from insurance or government programs—healthcare providers are left to absorb the costs. Over time, this financial strain can force facilities to close their doors, leaving already vulnerable populations with even fewer options for medical care.
For many Democrats, the proposed subsidy is a pragmatic solution to a complex problem. By helping more people afford health insurance, the thinking goes, the government can reduce the amount of uncompensated care that hospitals and clinics are forced to provide. This, in turn, could help stabilize struggling healthcare providers and ensure that more Americans—regardless of their income or immigration status—have access to essential services.
Yet, the issue is hardly cut and dry. Critics of the plan, including some Republican lawmakers, have expressed concerns about the cost of the subsidies and the possibility that they might encourage illegal immigration or reward those who only recently became eligible for assistance. Speaker Johnson (R-LA), for instance, has cited figures as high as $1.4 trillion when discussing the potential price tag—a number Smith flatly rejected during his Newsmax appearance.
“It’s not $1.4 trillion,” Smith insisted, seeking to dispel what he described as misinformation. “All we’re asking for in the short term CR is this tax credit, which is not $1.4 trillion.” The dispute over the numbers reflects a broader challenge in American politics: How to balance the need for fiscal responsibility with the moral and practical imperative to provide healthcare for those in need.
The COVID-19 pandemic added another layer of complexity to the debate. During the public health emergency, millions of Americans who might not have otherwise qualified for government assistance found themselves newly eligible for subsidies or expanded Medicaid coverage. Now, as pandemic-era policies wind down, policymakers are grappling with the question of whether to continue offering support to those who benefited from temporary expansions.
For Smith and his Democratic colleagues, the answer is clear. Maintaining subsidies—even if it means covering people who became eligible during the pandemic—is not just a matter of compassion, but of economic common sense. “If people are uninsured, this is a burden on the whole healthcare system,” Smith reiterated. The logic is straightforward: When people lack insurance, they often delay seeking care until their conditions become more serious and expensive to treat. Hospitals end up providing care without compensation, driving up costs for everyone and threatening the viability of critical healthcare infrastructure.
Republicans, on the other hand, have argued that the government should focus its resources on citizens and legal residents, and that expanding subsidies could create perverse incentives. Some have warned that continuing pandemic-era policies indefinitely would set a dangerous precedent, making it harder to rein in spending or enforce immigration laws in the future.
The debate over healthcare subsidies is unfolding against a backdrop of broader fiscal and political tensions. With the deadline to avoid a government shutdown fast approaching, lawmakers face mounting pressure to find common ground. For now, the fate of the proposed subsidies—and the millions of Americans who stand to benefit from them—remains uncertain.
What is clear, however, is that the stakes are high. The closure of rural hospitals and clinics is not just an abstract policy concern; it is a real and present danger for communities across the country. As Smith put it, “health care is an enormous issue, and it’s a subsidy to help people buy health insurance.” Whether Congress can come together to address this challenge remains to be seen, but the urgency of the moment is undeniable.
As policymakers continue to negotiate, the outcome will have lasting implications not only for the federal budget, but for the health and well-being of millions of Americans. The debate may be contentious, but it is one the nation cannot afford to ignore.
