You could be forgiven for not realizing there’s a government shutdown going on, the second-longest one in U.S. history in fact. Between ICE terror campaigns, revenge prosecutions, summary executions of Caribbean (and now Pacific) fishing boat crews, and the literal destruction of the East Wing of the White House, there isn’t a lot of bandwidth for the void of federal appropriations and the furlough of over 750,000 employees.
Republicans are very much trying to conceal the shutdown from the general public. President Trump dubiously got the troops paid, and he’s trying to figure out how to pay air traffic controllers to prevent flight delays. There have been vindictive cuts to spending projects in blue states and attempted layoffs of federal workers, but the layoffs have been blocked, and stopping infrastructure projects that have yearslong timelines isn’t immediately felt. The House is completely out of session, probably to prevent a 218th vote to release the Epstein files, but also to just take the oxygen out of the room on the shutdown. It’s hard to report on an empty chamber. (House Republicans’ main vehicle to end the shutdown is totally out of date, and they still aren’t coming back to fix it.)
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Both sides feel they have a strong hand politically, and while the polling on who is responsible is mostly split, the lack of salience is the key feature. The business-as-usual nature of the shutdown helps keep it going.
But you can’t hide the government from the public forever. And the accountability moment that Democrats have warned about for months is finally upon us. People are opening up their mailboxes or going online and seeing massive increases to their health insurance premiums, kicking in next year.
The new prices won’t begin until January 1, but open enrollment begins on November 1—ten days from now—and new premium rates are publicly posted in at least a dozen states. Healthcare.gov, which 28 states use, will update prices by the beginning of next week. The average annual cost in 2025 of a family health insurance premium is $27,000, and the failure to maintain enhanced subsidies for Affordable Care Act exchanges means that more middle-class and working families will have to pay a greater portion of that.
In fact, the average exchange beneficiary will see their premium costs more than double, according to KFF, and specific numbers for older families making the median household income (around $80,000 a year) would have them pay $31,000 annually for a plan in Kentucky, $28,000 in Oregon, and $44,000 in Vermont. We’re talking increases above this year’s level of up to $2,000 per month in some cases.
The raw cost of premiums is set to rise 18 percent next year, and this will only get worse. When millions of people can no longer afford coverage and drop out, it will thin the risk pool, leading insurance companies to further hike premiums that families will have to cover.
There are certainly other consequences of the shutdown that will begin to peek through the haze, like the loss of food stamp benefits by November that 1 in 8 Americans rely on. But Democrats have laid the foundation for months about health insurance sticker shock. They made the conscious decision to condition government funding on avoiding this scenario. Now it’s here, and they are pouncing on the stories of rising premiums.
We should be clear that this premium apocalypse is a function of returning Obamacare subsidies to where they were in the original version of the law. That was poorly designed to target the middle class with bearing the bloat in the health care system, and no work was done on basic health plans or other public options at the state level. (A federal public option was stripped from the legislation by the threat of that exemplary moderate, Connecticut Sen. Joe Lieberman, to withhold his support unless it was dropped.) Now, Democrats are effectively warning that a return to their original vision of Obamacare spells doom. (And what we’re really talking about is how much the government should send to private insurance companies, a horribly inefficient way of ensuring health for American citizens.)
But Democrats are more trusted on this issue than Republicans, and they did put four years of enhanced subsidies and more affordable coverage in place when the pandemic hit. The ACA was seen as a “starter home” that could be built on, and Democrats built on it. It’s Republican neglect that is taking the wrecking ball to it, with all the political fallout on their backs.
So the question then becomes how Republicans will react. At the leadership level, it’s been mostly a stonewall. Senate Majority Leader John Thune (R-SD) has said that he would negotiate health insurance premium support with Democrats and even guarantee them a vote, but only after the shutdown ends (“I will not negotiate under hostage conditions, nor will I pay a ransom.”). House Speaker Mike Johnson (R-LA) has mostly said the same thing.
But the rank and file is starting to buckle. The evolving Rep. Marjorie Taylor Greene (R-GA) came out for dealing with the subsidies after learning out-of-pocket premium costs would double. And 13 Republican frontliners asked Speaker Johnson to “immediately” extend the expiring subsidies, though they still want to end the shutdown first.
Clearly, the nerves are fraying. The fact that Trump is demolishing the East Wing, bailing out Argentina with $20 billion (allegedly a “mission-critical” operation that must continue despite the shutdown), and seeking an extortion of $230 million from the Justice Department for alleged punitive damages in prior cases against him offers many opportunities to fray nerves even more. Paying for this nonsense while an average family is going to be priced out of health insurance won’t play well.
That said, there is a lot of internal conservative resistance to any kind of social spending. Trump is clearly checked out on it; he maybe thinks he can blame Obama for it somehow. And even as Republican leaders are starting to talk about the subsidies, they want to attach unspecified “reforms” to them, like an income cap or a minimum out-of-pocket cost or a mechanism that only extends subsidies for existing enrollees, plus adding in some long-sought conservative policy ideas.
I should note, however, that an income cap is precisely what the current subsidies will revert to! That’s what’s created the cliff effect above 400 percent of the federal poverty line. Responding to unaffordable insurance for the middle class by putting in place something functionally equivalent isn’t going to work.
But this back-and-forth would at least be a normal negotiation aimed at a normal compromise. It’s what happens when both parties want something out of a negotiation. The problem, of course, is Donald Trump, who has shown a congenital inability to abide by the terms of any negotiation.
That’s where this whole thing may reach a dead end. You cannot make a deal with someone who won’t honor it. The guardrails aimed at forcing the deal to be honored have faded into the background. Ending the shutdown in exchange for a health care negotiation doesn’t guarantee the results of that health care negotiation will ever be implemented. I can envision some eventual compromise on the subsidies, because it’s in the political interest of Republicans. But as long as we’re having a shutdown fight that isn’t about the reason for the shutdown, this unmentioned obstacle will frustrate efforts at a solution.
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