compromise

WASHINGTON — The government shutdown has reopened debate on what has been a central issue for both major political parties in the last 15 years: the future of health coverage under the Affordable Care Act.

Tax credits for people who get health insurance through the marketplaces created by the Affordable Care Act, also known as Obamacare, expire at the end of the year.

Democrats say they won’t vote to reopen the government until Republicans negotiate an extension of the expanded subsidies. Republicans say they won’t negotiate until Democrats vote to reopen the government. Lawmakers in both parties have been working on potential solutions behind the scenes, hoping that leaders will eventually start to talk, but it’s unclear if the two sides could find compromise.

As Congress circles the issue, a poll from The Associated Press-NORC Center for Public Affairs Research found that about 6 in 10 Americans are “extremely” or “very” concerned about their health costs going up in the next year. Those worries extend across age groups and include people with and without health insurance, the poll found.

A look at the subsidies that are expiring, the politics of the ACA and what Congress might do:

Enhanced premium help during the pandemic

Passed in 2010, the ACA was meant to decrease the number of uninsured people in the country and make coverage more affordable for those who don’t have private insurance. The law created state by state exchanges, some of which are run by the individual states, to try to increase the pool of the insured and bring down rates.

In 2021, when Democrats controlled Congress and the White House during the COVID-19 pandemic, they expanded premium help that was already in the law. The changes included eliminating premiums for some lower-income enrollees, ensuring that higher earners paid no more than 8.5% of their income and expanding eligibility for middle-class earners.

The expanded subsidies pushed enrollment to new levels and drove the rate of uninsured people to a historic low. This year, a record 24 million people have signed up for insurance coverage through the ACA, in large part because billions of dollars in subsidies have made the plans more affordable for many people.

If the tax credits expire, annual out-of-pocket premiums are estimated to increase by 114% — an average of $1,016 — next year, according to an analysis from KFF.

Democrats push to extend subsidies

Democrats extended those tax credits in 2022 for another three years but were not able to make them permanent. The credits are set to expire Jan. 1, with Republicans now in full control.

Lacking in power and sensing a political opportunity, Democrats used some of their only leverage and forced a government shutdown over the issue when federal funding ran out on Oct. 1. They say they won’t vote for a House-passed bill to reopen the government until Republicans give them some certainty that the subsidies will be extended.

Democrats introduced legislation in September to permanently extend the premium tax credits, but they have suggested that they are open to a shorter period.

“We need a serious negotiation,” Senate Democratic leader Chuck Schumer has repeatedly said.

Republicans try to scale the ACA back, again

The Democratic demands on health care have reignited longstanding Republican complaints about the ACA, which they have campaigned against for years and tried and failed to repeal in 2017. Many in the party say that if Congress is going to act, they want to scrap the expanded subsidies and overhaul the entire law.

The problem is not the expiring subsidies but “the cost of health care,” Republican Sen. Rick Scott of Florida said Tuesday.

In a virtual briefing Tuesday, the libertarian Cato Institute and the conservative Paragon Health Institute branded the subsidies as President Joe Biden’s “COVID credits” and claimed they’ve enabled fraudsters to sign people up for fully subsidized plans without their knowledge.

Others have pitched more modest proposals that could potentially win over some Democrats. Senate Majority Leader John Thune, R-S.D., has said he is open to extending the subsidies with changes, including lower income limits and a stop to auto-enrollment that may sign up people who don’t need the coverage.

The ACA is “in desperate need of reform,” Thune has said.

House Republicans are considering their own ideas for reforming the ACA, including proposals for phasing out the subsidies for new enrollees. And they have begun to discuss whether to combine health care reforms with a new government funding bill and send it to the Senate for consideration once they return to Washington.

“We will probably negotiate some off-ramp” to ease the transition back to pre-COVID-19 levels, said Maryland Rep. Andy Harris, the head of the conservative House Freedom Caucus, during a virtual town hall Tuesday.

Is compromise possible?

A number of Republicans want to extend the subsidies. Sen. Josh Hawley, R-Mo., said most people who are using the exchanges created by the ACA “don’t really have another option, and it’s already really, really expensive. So I think there are things we can do to reform the program.”

Hawley said he had been having conversations with other senators about what those changes could be, including proposals for income limits, which he said he sees as a “very reasonable.”

Bipartisan groups of lawmakers have been discussing the income limits and other ideas, including making the lowest-income people pay very low premiums instead of nothing. Some Republicans have advocated for that change to ensure that all enrollees are aware they have coverage and need it. Other proposals would extend the subsidies for a year or two or slowly phase them out.

It’s unclear if any of those ideas could gain traction on both sides — or any interest from the White House, where President Donald Trump has remained mostly disengaged. Despite the public stalemate, though, lawmakers are feeling increased urgency to find a solution as the Nov. 1 open enrollment date approaches.

Democratic Sen. Jeanne Shaheen of New Hampshire has been talking to lawmakers since the shutdown began, trying to find areas of compromise. On Tuesday, she suggested that Congress could also look at extending the enrollment dates for the ACA since Congress is stalled on the subsidies.

“These costs are going to affect all of us, and it’s going to affect our health care system,” she said.

Jalonick writes for the Associated Press. AP writers Lisa Mascaro and Joey Cappelletti in Washington and Ali Swenson in New York contributed to this report.

As the partial government shutdown grinds on, with no end in sight, Catherine Cortez Masto stands ready to end it right now.

The lawyerly senator from Nevada is one of just two Democrats to repeatedly vote with Republicans and Maine’s independent senator, Angus King, to have the federal government up and running.

She’s not only bucking her Senate colleagues with her contrarian stance, but also placing herself squarely at odds with the animating impulse of her party’s political base: Stop Trump! Give no quarter! Now is the time! This is the fight!

Cortez Masto evinces not a flicker of doubt.

“I have been very consistent about the cost of a shutdown and the impact to Americans and the fact that I believe we need to work in a bipartisan way to find solutions to what we’re seeing right now, which is this looming healthcare crisis,” Cortez Masto said from Washington.

“And I think we can do that by keeping the government open. I don’t think we should do it by swapping the pain of one group of Americans for another.”

Unlike the Democrats’ other defector, Pennsylvania’s quirky Sen. John Fetterman, Cortez Masto hasn’t developed a reputation for partisan heresy, or antagonized party peers by playing footsie with President Trump and the MAGA movement.

Despite her temporary alliance with the GOP, she’s unstinting in her criticism of the president and the Republican stance on healthcare, the issue at the heart of the shutdown fight.

“Of course we need to stand up to Trump’s attacks on our families and our country,” she said. “I’ve been one of the most vocal opponents of Trump’s disastrous trade and tariff policies.”

Her split with fellow Democrats, she suggested, is not over ends but rather means.

It’s entirely possible, Cortez Masto insisted, to keep the government open for business and, at the same time, work through the parties’ differences over healthcare, including, most imminently, the end of subsidies that have kept insurance costs from skyrocketing.

It comes down to negotiation, trust and compromise, which in Cortez Masto’s view, is still possible — even in these rabidly partisan times.

“That’s what Congress is built on,” she said. “Congress is built on compromise, working together across the aisle to get stuff done. I still believe in it.”

Although she noted — with considerable understatement — “there are those in the administration and some of my colleagues” who disagree.

Not to mention a great many Democratic activists who believe anything short of jailing Trump and dispatching the entire GOP-run Congress to a far-off desert island amounts to cowardly capitulation.

Nevada, where Cortez Masto was born and bred, is a state that was Republican red for a very long time before turning blue-ish for a while, starting under Barack Obama in 2008. It went back to red-ish under Trump in 2024.

Cortez Masto, a former state attorney general, was first elected to the Senate in 2016, replacing the onetime Senate majority leader, Harry Reid, after the Democrat retired.

Six years later, when she sought reelection, Cortez Masto was widely considered Democrats’ most endangered incumbent. She was not nearly as powerful or prominent as Reid had been. Inflation was raging, and Nevada was still suffering an economic hangover from the COVID-19 pandemic.

Her opponent was a middling Republican, Adam Laxalt, a failed gubernatorial candidate and one of the architects of Trump’s Big Lie about the 2020 election. He also seemed to harbor a soft spot for the Jan. 6, 2021, rioters.

Still, Cortez Masto barely beat him, winning by fewer than 10,000 votes out of more than 1 million cast. In retrospect, the result could be seen as a harbinger of Trump’s success in carrying the state after twice losing Nevada.

Cortez Masto next faces reelection in 2028, which is politically ages away. By then, the shutdown will be long forgotten. (And presumably long over.)

Her focus, she said, is the here and now and, especially, the shutdown’s economic effect at a time Nevada is already feeling the negative consequences of Trump’s trade and immigration policies. Las Vegas, which runs on tourism, has experienced a notable slump, and Cortez Masto suggested the shutdown only makes things worse.

That, however, hasn’t deterred Nevada’s other U.S. senator, Jacky Rosen, who has repeatedly voted alongside nearly every other Democrat to keep the government shuttered until Republicans give in.

“Nevadans sent me here to fight for them,” Rosen said in a speech on the Senate floor. “Not to cave.”

Asked about the fissure, Cortez Masto responded evenly and with diplomacy. “She’s a good friend.… Our goal is to fight for Nevada and we are doing it,” she said. “We both are doing it in different ways.”

So, negotiation. Bipartisanship. Compromise.

What makes Cortez Masto think Trump, who’s run roughshod over Congress and the courts, can be trusted to honor any deal Democrats cut with Republicans to reopen the government and address the healthcare crisis she sees?

“Well, that’s the rub, right? We know what he’s doing,” she replied. He’s “flouting the law when it comes to … taking the role of legislators and appropriating funds at his own whim…. So, of course, no, you can’t trust him.

“But he is there. What you got to figure out is how you work together with Republican colleagues to get something done.”

Cortez Masto noted, dryly, that Congress is, in fact, a separate branch of government with its own power and authority. Republicans have ceded both to Trump and if they really want to solve problems, she said, and do more than the president’s bidding, they “need to come out and do bipartisan legislation to push back on this administration.”

“We’ve got to govern,” Cortez Masto said. “We’ve got to work together.”

Wouldn’t that be something.