As the federal government shutdown drags into its third week, a new crisis is looming for millions of Americans who rely on the Affordable Care Act (ACA) for their health insurance. The enhanced premium tax credits, which were expanded during the COVID-19 pandemic and have since helped lower or even eliminate monthly premiums for many, are set to expire at the end of 2025. With open enrollment for ACA plans beginning on November 1, 2025, uncertainty and anxiety are mounting across the country.
According to a recent analysis from KFF, if Congress fails to act, premium payments could more than double in 2026 for those who depend on these subsidies. This stark possibility has become a central point of contention in the ongoing government funding standoff, with Democrats and Republicans deadlocked over how and when to address the issue.
For Doug Butchart, a 67-year-old retired mechanic from Eglin, Illinois, the stakes are personal and immediate. His wife, Shadene, 58, has amyotrophic lateral sclerosis (ALS), a progressive and costly disease. The couple currently pays $603.82 per month for a gold-tier insurance plan after receiving $670 in enhanced premium tax credits that offset their $1,273.82 monthly premium. Butchart told ABC News, "I've heard [premiums could rise] anywhere from 25 to 50%. And that's not sustainable because we can't afford that but can't afford to not have insurance."
Their situation is complicated by a gap in the safety net. Shadene does not qualify for Medicare because she lacks the necessary work credits, and their income is too high for Medicaid. "We're stuck like in the middle because, normally with an ALS diagnosis, you're automatically eligible for [Social Security Disability Insurance] and Medicare, but she doesn't have any work credits, so she doesn't qualify for Social Security Disability," Butchart explained. "So right now, we're doing everything off of my Social Security, and it's very hard to try and pay all the bills and keep insurance and, if they mess around with the marketplace insurance, it's going to make it impossible for us to afford insurance."
With the future of their coverage in doubt, the Butcharts are scrambling to make the most of their current insurance while they can. They're trying to secure a specialized wheelchair for Shadene, which could cost between $65,000 and $95,000. "You work your entire life to make yourself comfortable and I'm sure there are things that we could do without but there's not that much crazy spending to possibly have to cover $1,500 a month for insurance," Butchart said. "That's a lot of money. ... You don't realize how important insurance is until you need it."
Nancy Murphy, a 60-year-old retired nurse from Fort Lauderdale, finds herself in a similar predicament. For the first time this year, she was able to get coverage through the ACA with Florida Blue. Her $1,019 monthly premium is currently covered entirely by the enhanced tax credits. But if those subsidies disappear, Murphy fears she will not be able to maintain her coverage. "It's very much a worry. I definitely could not afford that if the tax credits expire," she told ABC News. "It's a scary thought as a type 1 diabetic."
Murphy relies on an insulin pump, which is covered without a co-pay under her current plan, but she still faces $30 monthly co-pays for other diabetes supplies. With additional financial responsibilities like property taxes and her daughter's college tuition, she says the uncertainty is overwhelming. "I'm like in limbo and it's a really uncomfortable feeling," Murphy said. "I like to budget and plan out my budget. With tuition, property taxes and repairs that need to be done around the house, I need to map these out." She added, "These things to me are so upsetting. We are American citizens. We should be able to access our tax dollars for our health care needs."
Democrats in Congress, led by House Minority Leader Hakeem Jeffries, have made it clear that extending the ACA subsidies is a top priority—and a key sticking point in negotiations to reopen the government. According to NPR, Jeffries told reporters he believes "it will become readily apparent to people throughout America why it is so important for Congress to act to extend the Affordable Care Act tax credits." He warned that, without action, "tens of millions of Americans are receiving notices as we speak, indicating that their health insurance premiums, co-pays and deductibles are about to skyrocket double, triple — or in some cases, quadruple — at levels that will be unaffordable."
Jeffries cited data showing that monthly health insurance premiums could increase by approximately $2,000, or over $24,000 a year, for those losing the tax credits. Considering that the average income of ACA tax credit recipients is around $63,000 a year, such increases would be unsustainable. "Clearly, these type of premium increases for people to get access to a doctor when they need them are unsustainable," he said.
Some Republicans have proposed a one-year extension of the subsidies, a move Jeffries has rejected as insufficient. He argued that, "If billionaires can be provided tax breaks on a permanent basis in ways that will explode the deficit all across the country and result in people losing their health insurance … it seems to us that Republicans should come to the table to provide a greater degree of certainty as it relates to health care that's being provided to working class Americans."
The political standoff is further complicated by the mechanics of the shutdown itself. Republicans insist that negotiations over health care subsidies can only begin after a "clean" funding bill is passed and the government is reopened. Democrats, meanwhile, say they will not back down from their demand to address the subsidies as part of any deal to end the shutdown.
In the meantime, open enrollment for ACA insurance is set to begin on November 1, 2025, and will run through early to mid-December. As Jeffries pointed out, the pressure on Congress to act will only intensify as more Americans receive notices about potential premium hikes and face the prospect of unaffordable coverage. "The pressure is going to continue to mount on the Congress to take decisive action during that period of time, as people all across America realize that things are about to get extremely costly in states like Georgia, Virginia and Maryland," he said.
Underlying the partisan wrangling are the real lives of people like the Butcharts and Murphy, who are trying to plan for their health and financial futures amid a cloud of uncertainty. For them, the debate in Washington is not just about political leverage—it's about whether they can afford to stay healthy, manage chronic conditions, and avoid financial ruin.
As the shutdown continues and the deadline for extending the ACA enhanced premium tax credits approaches, the stakes for millions of Americans could not be higher. The coming weeks will test whether Congress can find a solution that keeps health care affordable for those who need it most.
