The government shutdown is now the longest in U.S. history. The ongoing 36-day closure has sparked disputes over a range of topics — from the separation of powers and the federal workforce, to food assistance and air traffic control.
But at the heart of the impasse is a debate about health care, specifically expiring subsidies for health insurance premiums purchased on the Affordable Care Act marketplace.
Democrats have gone all-in on their fight to preserve the subsidies, withholding votes 14 times for a Republican-backed short-term spending measure even as shutdown pain ratchets up with flight cancellations, delayed SNAP benefits and missed paychecks for federal workers.
Though Republicans have insisted they will not negotiate on the subsidies until the government reopens, some members are calling for them to be preserved.
The stalemate has underscored the Affordable Care Act debate's lasting imprint on Washington, more than 15 years after it was signed into law. Clashes over health care have continued to animate pivotal moments in American politics, from consequential elections to paper-thin votes in Congress and even a past government shutdown in 2013.
Now the debate has stoked a record-long shutdown, just ahead of midterm elections in 2026, when health care could once again shape the results.
Why some Obamacare critics want to extend its subsidies
For more than a month, Democrats have refused to back a government funding measure without an agreement to extend subsidies for ACA marketplace plans, which expire at the end of the year.
That has left Republicans in a tricky position. While the party broadly dislikes the law, some in Congress have begun to acknowledge they may be stuck with it.
"This is a big deal in my district," said Rep. Jeff Hurd, R-Colo. "I've heard from a number of people who are facing dramatic increases."
Hurd says without the subsidies, constituents in his heavily rural district could lose health coverage.
Like most in his party, Hurd says reopening the government has to come first. He is also one of more than a dozen House Republicans who signed onto a letter calling for them to be preserved. And along with a pair of Democrats, Hurd and Rep. Don Bacon, R-Neb., outlined a bipartisan framework this week to temporarily extend the subsidies.
Even the conservative firebrand Rep. Marjorie Taylor Greene, R-Ga., has called for keeping them, despite her sharp criticism of Obamacare, saying the cost of health care is a top issue in her deep red district.
"The toothpaste is out of the tube," Greene wrote on X this month.
When the Affordable Care Act passed with zero Republican votes, this kind of acceptance would have been hard to imagine.
Fights over the ACA helped fuel a 2013 shutdown. Sen. Ted Cruz (R-Tex.) held the Senate floor for more than 21 hours, railing against Obamacare and memorably reading from Dr. Seuss' Green Eggs and Ham.
Former Republican House Majority Leader Eric Cantor says backlash against the law helped give birth to the Tea Party and later the Make America Great Again movement.
"There was a lot of trepidation as to what Obamacare was going to mean," Cantor said in an interview with NPR. "Whether you were going to be able to keep your doctor, whether there were going to be 'death panels,' and honestly a concern about the unknown."
Over the years, Republicans repeatedly tried to repeal and replace Obamacare.
"We still faced opposition from within our own ranks," said former Rep. Fred Upton, R-Mich., who chaired a key committee that tried to work on a substitute. "Here we are today, and there's still no alternative. It's been 15 years. It's not gonna go away."
Today, Upton says letting the subsidies expire could be disastrous for many Michiganders.
Even House Speaker Mike Johnson, R-La., has acknowledged that Obamacare is unlikely to be repealed.
Johnson and other Republicans, including President Trump, who talked about "concepts of a plan" to replace the ACA during a presidential debate last fall, have struggled to articulate concrete reforms.
"These ideas have been on paper for a long time," Johnson said recently. "There's volumes of this stuff. We've been working on it since day one of this Congress."
Polls show a majority of Republicans still oppose Obamacare, but the law's popularity has grown, says Ashley Kirzinger, director of survey methodology at the health policy organization KFF. More than half of marketplace enrollees live in Republican congressional districts.
"They're more likely to live in rural areas, to own a small business or be farmers," she said.
An October survey of competitive congressional districts by Republican pollster John McLaughlin, who has worked with Trump during each of his campaigns, also found overwhelming support for extending the subsidies. He says the results have been put in front of top advisers at the White House.
"Voters are definitely more likely to vote for somebody who's gonna support a healthcare tax credit that they can use versus those who might oppose it," McLaughlin said in an interview.
Some Democrats hoped Trump would get involved and cut a deal on subsidies to end the shutdown. But Trump has continued to bash Obamacare and has yet to embrace an extension of the subsidies.
And many rank-and-file Republicans remain skeptical of the Affordable Care Act, including Sen. Bill Cassidy, R-La., a gastroenterologist.
"Obamacare has become the 'Unaffordable Care Act," Cassidy said. "And the reforms that were supposed to lower costs are now being papered over with more and more subsidies."
Hurd, the Colorado congressman, agrees the subsidies only address a symptom of the ballooning cost of health care. Still, he says extending them is an imperative for him and many colleagues — and hopes this can also be an opportunity for a bipartisan conversation about health care.
"Whether it's something they're public about or not, if you're genuinely serious about serving your constituents, this ought to be something on your radar screen," Hurd said.
Why Democrats are all-in on their healthcare push
Meanwhile, Democrats are betting enormous political capital as they hold out for a subsidies deal, emboldened by what happened in 2018, when candidates running on health care swept the party back into the House majority.
That year, Andy Kim ran for a Republican-held congressional district in New Jersey. The incumbent, Rep. Tom MacArthur, was a key player in efforts to repeal and replace Obamacare, authoring an amendment that would have allowed states to waive the ACA ban on denying coverage over pre-existing conditions.
"Everyone was furious," Kim recalled. "He really touched a third rail."
That year in Michigan, Democrat Elissa Slotkin also challenged a Republican incumbent on health care.
"I think it was the dominant issue," Slotkin said. "My experience with my mom not having insurance when she was diagnosed with Stage 4 ovarian cancer just meant that a lot of people wanted to talk about it and I had a lot to say."
Kim and Slotkin won their races — part of a blue wave that gave Democrats control of the House. Eight years later, they are in the Senate, where Democrats have refused to back a stopgap spending bill without a deal to extend expiring ACA subsidies. Open enrollment began Nov. 1, when many Americans discovered that their premiums without the subsidies next year will skyrocket.
"That's 500,000 people in my state alone," Slotkin said. "You're talking about people who are going to be doubling their costs and then therefore deciding not to keep health care coverage."
"I think what's really telling is that we see not just majorities, but large majorities, of Republicans, independents and Democrats saying that they want Congress to extend the enhanced premium tax credits," KFF's Kirzinger said.
KFF has been polling on the ACA for years. The 2010 law is more popular than ever, a sea change from 15 years ago, when Americans were more evenly divided on the law.
"The best thing that happened to the Affordable Care Act politically was when Republicans started trying to take it away," said Meredith Kelly, a top Democratic congressional committee staffer during the 2018 midterms.
Leading up to that cycle, Kelly worried that Obamacare was a political liability for Democratic candidates. But then, with Trump in office, Republicans moved to destroy it.
"I think that the 2018 cycle was a massive turning point for the popularity of the ACA," Kelly said. "And I think that's in great part because Democrats worked really hard that cycle to help Americans understand what Republicans were ripping away."
Democrats think health care will resonate again in the 2026 midterms, despite the onslaught of news that has characterized Trump's second term. Riding the Senate subway, Kim says 2018 was chaotic, too, and still the health care message cut through.
"I think sometimes we don't remember how turbulent and crazy the first term was as well," Kim said.
Hustling to another vote on the Republican funding bill, Slotkin said she does not know whether health care will play the same driving role it did in 2018. But she says there is reason to believe it will.
"Among all of the major ways people are paying more and the cost of living is going up, I can't think of something that is more personal than health care," she said.
Will the shutdown reshape the health care debate?
Throughout the shutdown, Republicans have slammed the high cost of the subsidies, calling them a relic of the pandemic-era and no longer needed. They also have accused Democrats of holding the government hostage to extract policy concessions, putting federal workers and others in the crosshairs.
"I'm still at a loss as to what exactly they're trying to get out of this," Senate Majority Leader John Thune, R-S.D., said Tuesday. "While they may believe politically that it's in their best interests, it's certainly not in the best interests of the American people ... Nobody wins. Shutdowns are stupid."
Kelly, the Democratic strategist, thinks Democrats will win that argument in the long run.
"What I do hope the American people understand before next November is that Democrats are on the side of lowering their costs and protecting their health care, and Republicans are not," she said. "That will be the lasting impact of this shutdown."
Not all Democrats agree that the shutdown consequences will be worth it. Sen. Catherine Cortez Masto, D-Nev., has been one of three in her caucus voting with Republicans to reopen the government.
"I don't think we should swap the pain of some Americans for others," she told reporters. "I think we can keep the government open and address the looming crisis of the health care cliff that we are seeing."
Republicans hoped more Democrats would see it that way as the shutdown dragged on. This week, some have signaled they may now accept just the promise of a vote on the subsidies.
For now, the shutdown may soon stretch into a sixth week, with the subsidies still set to expire.
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