Political Risks in ACA Subsidy Debate Spark Blame Game, Test Parties’ Resolve

A clash over the Affordable Care Act that has led to a shutdown of the federal government has ramifications for public health as agencies cease some services. The Trump administration vows mass layoffs during the impasse. 

The shutdown centered largely on a disagreement over the Obama-era health law. Democrats want a further extension of enhanced subsidies that reduce ACA health insurance premiums, but GOP lawmakers insist any debate wait until after a budget deal is reached to keep the federal government afloat. 

With the sides far apart, federal funding ran out at midnight Oct. 1 after Congress failed to pass even a stopgap budget. The issue now is how long the deadlock will continue. 

In a KFF poll released today, more than three-quarters — 78% — of the public say they want Congress to extend the enhanced tax credits available to people with low and moderate incomes. That includes more than half of Republicans and “Make America Great Again” supporters. The poll was conducted just prior to the Oct. 1 shutdown. 

The Department of Health and Human Services has said it expects to furlough about 40% of its workforce, which has already been downsized by about 20,000 positions under the Trump administration. Across the federal government, roughly 750,000 employees will be furloughed, according to an estimate by the Congressional Budget Office. While they won’t be working, those employees will get back pay for their missed compensation, totaling about $400 million daily, the CBO estimated. 

The two parties are blaming each other. 

“We’re not going to simply go along to get along with a Republican bill that continues to gut the health care of everyday Americans,” House Minority Leader Hakeem Jeffries said of pressure to reach a budget deal. 

Republicans, meanwhile, have blasted Democrats for holding up funding over the subsidies and say any deal will require concessions. 

“If there were some extension of the existing policy, I think it would have to come with some reforms,” Senate Majority Leader John Thune said Sept. 26. 

In the KFF poll, people supportive of an extension said the blame, if the effort fails, would fall mostly on President Donald Trump (39%) and Republicans in Congress (37%). A smaller share, 22%, say congressional Democrats would deserve the most blame. A Washington Post poll out Thursday also found people were more likely to blame congressional Republicans and the White House. 

Several Republicans have expressed interest in extending the subsidies. Within days, ACA enrollees are expected to get notices from their insurers advising them of steeper premiums.

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