Representative Katherine Clark, a Democrat from Massachusetts, during a rally for healthcare funding with Democratic lawmakers outside the US Capitol in Washington on Sept. 30. Photographer: Graeme Sloan\/Bloomberg <\/p>\n
(Bloomberg) — The health insurance subsidies at the center of the US government shutdown fight disproportionately benefit areas of the country represented by Republican lawmakers, posing a potential vulnerability for President Donald Trump\u2019s party in next year\u2019s midterm congressional elections.<\/p>\n
Twelve million Americans in Republican-held US House districts are covered by health plans purchased through Affordable Care Act exchanges versus nine million living in Democratic-held districts. Of the 75 districts where at least 10% of the people are enrolled in Obamacare policies, 47 are represented by Republicans in the House, according to 2024 data compiled by KFF, a nonpartisan health research foundation.<\/p>\n
Most Read from Bloomberg<\/p>\n
<\/p>\n
The disparity helps explain the political rationale for Democrats to focus attention on their demands to renew Obamacare subsidies set to expire at the end the year. It also likely contributes to some Republican lawmakers\u2019 eagerness to find a way to extend the subsidies, even if they don\u2019t want to give Democrats a shutdown victory.<\/p>\n
\u201cIt is districts in deep red states that have the highest ACA enrollment,\u201d said Larry Levitt, executive vice president of health policy at KFF. \u201cA big part of the MAGA coalition\u201d benefits from the insurance subsides, including small business owners, farmers and workers in jobs without employer-provided coverage, he added.<\/p>\n
Ironically, that\u2019s in part because of Republican office-holders\u2019 hostility to the health insurance program started by Democratic President Barack Obama. Republican-run states, particularly in the South, rejected the federally subsidized Medicaid expansion available under Obamacare so more residents receive coverage through ACA policies.<\/p>\n
\u2018Supercharged\u2019<\/p>\n
The enhanced premium tax credits adopted during the Covid-19 pandemic \u201csupercharged\u201d Obamacare enrollment, Levitt said.<\/p>\n
Obamacare subsidies are broadly unpopular among Republican lawmakers, who see the assistance as too costly and bolstering an expanded government role in health care, as well as closely associated with a Democratic president. A permanent extension of the enhanced premium credits would cost $350 billion over 10 years, according to the nonpartisan Congressional Budget Office.<\/p>\n
Democrats are already incorporating the expiring tax credits into a broader campaign message to voters, blaming Republicans for rising health-care costs. While the Medicaid cuts Trump incorporated into his signature tax law won\u2019t take effect until after the midterm elections, voters will feel the impact of the lost Obamacare subsidies soon.<\/p>\n
Democrats are seeking to replicate their success in the 2018 midterms during Trump\u2019s first term, when they ran against GOP efforts to repeal the Affordable Care Act, flipped 40 seats and retook control of the House.<\/p>\n
The risk to Republicans is that Democrats persuade voters a spike in Obamacare premiums driven by expiration of the subsidies is the \u201cfirst tranche of Republican health-care cuts,\u201d said Dean Rosen, a former senior Republican Senate aide who is now a partner at Mehlman Consulting, a lobbying firm with health-industry clients that benefit from broader insurance coverage.<\/p>\n
\u201cIf so, this is something that will bite in a real way prior to the midterms,\u201d he added.<\/p>\n
Representative Katherine Clark, a Democrat from Massachusetts, during a rally for healthcare funding with Democratic lawmakers outside the US Capitol in Washington on Sept. 30.Photographer: Graeme Sloan\/Bloomberg <\/p>\n
Without the subsidies, premiums on average are expected to jump 114%, according to KFF. That could be more dramatic for older Americans, especially in rural areas where there\u2019s less competition from health care providers to put a check on costs. Without the subsidies, 4 million people will lose health coverage, the nonpartisan Congressional Budget Office forecasts.<\/p>\n
Amy Bielawski, a 60-year-old small business owner in Tucker, Georgia, is among them. The subsidies lowered her current health insurance premiums to about $30 a month.<\/p>\n
Bielawski, who had been uninsured for most of her life until the enhanced premium tax credits began in 2021, runs Hare-Brained Productions, which provides entertainers for parties and events. She relies on insurance to cover doctors\u2019 visits she needs to get prescriptions for a thyroid disorder.<\/p>\n
\u201cIf it goes up to 100 bucks a month that\u2019s probably going to put me over the edge,\u201d Bielawski said.<\/p>\n
WATCH: The US government shutdown extended to a third day while lower-level negotiations have failed to strike a deal. Laura Davison reports.Source: Bloomberg <\/p>\n
\u2018Engaged Constituency\u2019<\/p>\n
Bielawski\u2019s home state is shaping up to be one of the key battlegrounds in the 2026 midterms, with Senator Jon Ossoff, a Democrat, defending his seat in a state Trump won by 2 percentage points last November.<\/p>\n
Senator Raphael Warnock of Georgia, who\u2019s also a Democrat, remarked on Friday that the burden could fall on areas represented by GOP lawmakers. \u201cA lot of this pain will be felt in their districts,\u201d he said. \u201cThis is really not a Democrat and Republican issue.\u201d<\/p>\n
Democrats are already running online ads in 35 Republican-held House districts they\u2019re targeting next year, blaming Republicans for rising health-care costs.<\/p>\n
In at least eight districts the nonpartisan Cook Political Report has rated as \u201ctoss-ups\u201d in 2026, ACA enrollment as a percentage of the population exceeds the 2024 vote margin. That includes races in Arizona, Nebraska, Pennsylvania, Colorado and Iowa.<\/p>\n
\u201cThis will be a very engaged constituency,\u201d Levitt said.<\/p>\n
It\u2019s also possible the issue could force Republicans to defend typically safe seats, Levitt said, pointing to Texas and Florida.<\/p>\n
Each of Florida\u2019s 28 congressional districts, the majority of which are held by Republicans, have more than 10% of their residents enrolled in ACA exchanges. Enrollment exceeds 30% in five Florida districts, three of which are represented by Republicans, according to KFF data.<\/p>\n
An Obamacare sign outside an insurance agency that offers plans under the Affordable Care Act, in Miami in 2021.Photographer: Joe Raedle\/Getty Images <\/p>\n
Two of those Republicans, Representatives Maria Elvira Salazar and Carlos Gimenez, are teaming up with a bipartisan group pushing for a one-year extension of the tax credits. The group, led by GOP Representative Jen Kiggans of Virginia, comprises swing-district lawmakers like Kiggans, as well as members from comparatively safe seats with high ACA enrollment.<\/p>\n
A 64-year-old making $63,000 a year in Gimenez\u2019s and Salazar\u2019s districts would see premiums for a mid-tier silver plan jump at least 170% from current levels to more than $1,200 a month, according to KFF\u2019s data tool.<\/p>\n
Extending the tax credit would mean \u201cproviding critical relief and ensuring millions of families can keep their coverage without facing massive cost increases,\u201d Gimenez said in a statement. Salazar\u2019s office did not respond to a request for comment.<\/p>\n
Baked In<\/p>\n
Still, most Republican lawmakers oppose extending the subsidies.<\/p>\n
Republicans, especially those in safe seats, may see Democrats\u2019 attacks on health care as already baked into the political equation, Mehlman\u2019s Rosen said.<\/p>\n
\u201cThey know that Democrats are going to spend millions of dollars in the midterms beating them up on health care,\u201d Rosen said, of Republicans\u2019 political calculus. \u201cDo I really want to sit down and spend tens of billions of dollars if I\u2019m still going to get whacked by all these ads for cutting trillions in Medicaid?\u201d<\/p>\n
(Updates with Warnock, in 17th paragraph.)<\/p>\n
Most Read from Bloomberg Businessweek<\/p>\n
\u00a92025 Bloomberg L.P.<\/p>\n","protected":false},"excerpt":{"rendered":"Representative Katherine Clark, a Democrat from Massachusetts, during a rally for healthcare funding with Democratic lawmakers outside the…\n","protected":false},"author":3,"featured_media":275273,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[7023,3638,7030,142404,49089,210,1141,3168,1142,142406,3173,84294,142405,5005,44222,5620,67,132,68],"class_list":{"0":"post-275272","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-affordable-care-act","9":"tag-bloomberg","10":"tag-congressional-budget-office","11":"tag-democratic-lawmakers","12":"tag-government-shutdown","13":"tag-health","14":"tag-health-care","15":"tag-health-insurance","16":"tag-healthcare","17":"tag-katherine-clark","18":"tag-kff","19":"tag-larry-levitt","20":"tag-obamacare-subsidies","21":"tag-president-donald-trump","22":"tag-republican-lawmakers","23":"tag-republicans","24":"tag-united-states","25":"tag-unitedstates","26":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/115311771826395650","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/275272","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=275272"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/275272\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/275273"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=275272"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=275272"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=275272"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}