What’s Next for Obamacare Fight After Government Shutdown Ends

The government shutdown is nearly over, but the health-care fight at its core lingers on, and could consume Congress for weeks.

While the Senate voted to reopen the government Monday night, and the House is likely to do so in the coming days, there’s still no resolution over the expiring Affordable Care Act subsidies that help people across the country purchase health insurance through the law.

Without an extension, millions of Americans face steep premium hikes starting in January. The issue is also set to play a central role in the 2026 midterm elections, which will decide control of the House and Senate.

Major stumbling blocks remain in the way of any deal on a law that has proven to be among the most divisive in US politics. New, ongoing negotiations could bring a compromise, or competing proposals that fail, leaving the fight to continue through Election Day next year.

The tax credits, which help lower premium payments for ACA enrollees, were temporarily increased during the Biden administration, and Congress removed an income limit so more people could benefit. Those enhancements expire at year’s end, setting up the debate over what happens next.

Here are some key issues and dates to watch as the debate enters a new phase.

How long of an extension is acceptable?

The timing of any solution could have significant political impacts.

Some lawmakers, including Sen. Thom Tillis (R-N.C.), have floated a two-year fix. The first year, he says, would continue the program as is, while cost-saving changes — potentially including an income cap — would take effect in year two.

That would kick potential price hikes and cuts in eligibility past next year’s elections, aiding Republicans’ political prospects.

A one-year extension would instead buy time for lawmakers to work out a longer solution. But it would also mean they’ll be negotiating this very issue again in a matter of months, with the pressure of upcoming elections.

It would also create uncertainty for the people who depend on the ACA for health coverage.

Will the House act?

A handful of Republican senators say they’re willing to negotiate over the subsidies.

But health care has flummoxed Republicans for years. Many in the GOP despise the law often called Obamacare, while others fear the backlash if they wipe out its popular benefits. They’ve never developed an alternative that unites their party.

That all leaves the House GOP in in a bind. Republicans said they wouldn’t negotiate during a shutdown, but without a deal they could bear responsibility for significant cost increases on their watch.

House Speaker Mike Johnson (R-La.) has been non-committal about even allowing a vote on the subsidies, and offered little clarity Monday.

“We have always been open to finding solutions to reduce the oppressive costs of healthcare under the unaffordable care act. We just made clear that we would not and should not,” negotiate “as hostages,” he told reporters.

Do Republicans have an alternative?

President Donald Trump has called on Congress to send subsidies directly to consumers, instead of insurers. Senate Republicans are urging him to get involved as they search for unity.

“Whatever we do as Republicans, we got to really work close with the president,” Sen. Markwayne Mullin (R-Okla.) said.

Senate Finance Republicans met Monday to discuss the expiring credits. Sen. Bill Cassidy (R-La.) pitched federally funded flexible spending accounts. But his effort is still a work in progress.

“Don’t be impatient,” Cassidy said after the meeting. “I started talking about this two days ago.”

The GOP has called for setting income limits for people receiving the subsidies, among other modifications.

History, however, has shown how hard it is for Republicans to unite on health care. Any solution they offer will likely require Democratic support in both chambers to pass.

Will Democrats compromise?

Democrats for months have demanded an extension, blaming Trump and Republicans for the notices already landing in mailboxes informing people of price increases. Now they may have to choose between a policy win that helps millions of people and a political win they can take into the midterms.

A bipartisan deal to save the subsidies would bolster the ACA and avert price hikes.

But it would also neutralize a potentially potent issue. Democrats have made clear they plan to highlight the fight in their campaigns, mirroring the messages they used in 2018, after the GOP tried to repeal the ACA. It helped Democrats win the House.

Democrats are “going to continue to lean in to the fight over the next few days and beyond, until we actually get an outcome that makes life better for working class Americans,” House Minority Leader Hakeem Jeffries (D-N.Y.) said Monday.

What are the key dates?

As part of the deal to reopen the government, Senate Majority Leader John Thune (R-S.D.) promised Democrats a vote on their proposal “no later than the second week in December.”

Democrats should pitch a plan “in that sweet spot” that can help people and win GOP votes, said Sen. Tim Kaine (D-Va.), who supported the deal to reopen the government.

Republicans are working on their own proposal that could also get a vote. Cassidy said he could have legislation ready by Dec. 12, and whether or not the effort is bipartisan would be up to Democrats.

The new spending bill goes through Jan. 30, offering Democrats another deadline with leverage that could put Congress on the brink of a shutdown again.

“We’ll take it one day at a time,” Thune said. “Obviously it’s another deadline we have to deal with.”