The Health Care Tax Credit Debate Behind the Government Shutdown

For the first time in nearly seven years, the federal government shut down on October 1, 2025.

Government shutdowns aren’t new to Washington. Since the late 1970s, there have been 20 funding gaps. Some lasted only a few hours, while others have lasted several weeks.

The longest? During President Donald Trump’s first term, a border wall funding standoff lasted 35 days.

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During every shutdown, federal workers are often furloughed, agencies stall, and basic government services are interrupted, resulting in far-reaching economic consequences.

This time, however, the standoff behind the scenes notably centers on taxes and health care.

Specifically, Congress is battling over the extension of premium tax credits that help millions afford health insurance. (Reversing billions in Medicaid cuts that Trump and the GOP pushed through in their 2025 tax and spending bill are also at issue.)

So, the sheer scale of this year’s tax and health care concerns — potentially impacting nearly one in 14 Americans — adds an unusual twist to this current shutdown. Here’s more to know.

ACA Premium Tax Credits

At the heart of the 2025 government shutdown impasse is a widely used tax credit that subsidizes premiums for Affordable Care Act (ACA) marketplace insurance.

• Congress originally expanded these premium tax credits during the pandemic in 2021 and later extended them through the end of 2025.
• They substantially lower health insurance costs for more than 24 million people in the U.S., or roughly 7% of the population.
• Data show the tax credits have helped make coverage more affordable for a range of people, including the self-employed, small business owners, and those who lack access to employer or other coverage.

Congressional Democrats have made it clear they will not approve a temporary spending bill unless Republicans also agree to extend these enhanced credits and reverse scheduled Medicaid cuts.

Minority Leader of the U.S. House of Representatives Hakeem Jeffries (D-N.Y.) told reporters the following regarding rising health care premiums and the shutdown stalemate.

“In just days, tens of millions of Americans will see their health care costs rise sharply because of the failure to extend Affordable Care Act tax credits. It’s happening at a time when the cost of living is already too high.”

While some Republicans acknowledge the popularity of the tax credits, they reject the notion of tying any extension of them and/or any rollback of Medicaid cuts to a stopgap funding deal.

Vice President JD Vance said in a Fox News interview, “I will go to the Capitol right now to discuss premium support for the Affordable Care Act with Chuck Schumer and Senate Democrats, but only after they have reopened the government.”

Medicaid cuts are also part of the shutdown battle

As Kiplinger has reported, scheduled Medicaid cuts ushered in by the GOP megabill signed into law by Trump on July 4, 2025, risk curtailing coverage and access for millions of low-income families, increasing the uninsured rate, and shifting costs onto hospitals and local governments. Many rural hospitals could be forced to close.

Many Democrats insist that both protections — the ACA credits and broader Medicaid funding — remain in place.

The GOP megabill, nicknamed the “big, beautiful bill,” includes a cut of approximately 15% to Medicaid spending, totaling nearly $1 trillion over the next ten years. According to the nonpartisan Congressional Budget Office (CBO), these cuts could result in approximately 7.8 million people losing Medicaid coverage by 2034.

Note: The President and some Republican lawmakers have claimed in recent days that Democrats want to provide health care to illegal immigrants. It’s important to note that individuals in the U.S. illegally aren’t eligible for insurance coverage provided through the Medicare program or the ACA exchange.

Health insurance: What happens if ACA tax credits expire?

According to the Kaiser Family Foundation (KFF), ACA plan premiums could increase by an average of 114% if Congress allows the credits to expire. That could mean a jump from $888 this year to nearly $1,904 per year for a typical beneficiary.

• Some enrollment experts warn that more than 4 million people could leave the marketplace entirely, overwhelmed by the cost.
• The expiration would hit middle-income households that were newly eligible for the enhanced credits the hardest. Many would lose all subsidy support overnight if Congress doesn’t act before Dec. 31, 2025.
• KFF reports that ACA marketplace insurers, anticipating coverage lapses, are already raising their proposed 2026 rates, with some reportedly increasing by as much as 18%.

Medicaid, meanwhile, faces its own set of cascading effects if the cuts take effect.

Past state-level rollbacks have shown that reduced federal Medicaid funding often leads states to restrict eligibility, cut provider payments, or both. So, fewer people are being covered and a greater strain is being placed on emergency care systems.

For more information, see: How Five States Are Worse Off After SNAP, Medicaid Cuts.

Government shutdown 2025: What's at stake?

As open enrollment for ACA plans approaches, some insurers and policyholders alike are in limbo, unsure what premiums or coverage rules will look like. Some Medicaid participants wonder if new cuts could force them off coverage or reduce their access to care in the coming year.

As the government shutdown stretched into its third day, President Donald Trump issued stark warnings about potential layoffs of federal workers. On social media, he framed the shutdown as what he called an “unprecedented opportunity” to cut federal programs aligned with Democratic priorities.

In an interview reportedly taped on Wednesday with One America News, as reported by PBS, Trump added, “There could be firings, and that would be their responsibility. There might also be other actions. We could eliminate projects they favor, and those would be permanently cut.”

So what happens next is anyone’s guess. Stay tuned.

Related

• What to Know About Medicaid Cuts: Is Your Local Hospital Closing Soon?
• What Will the Government Shutdown Do to the IRS?
• Premium Tax Credit: Are You Eligible?