The U.S. Capitol building in Washington, D.C., amid fog on Tuesday, Dec. 10, 2024. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — U.S. senators began debating how to reduce health care costs for Americans during a hearing Wednesday, where experts’ varied recommendations and comments from lawmakers previewed the rocky and potentially long path ahead. 

Republicans on the Finance Committee argued the Affordable Care Act, or Obamacare, has led to a spike in health insurance costs for individuals  that shouldn’t be offset by tax credits any longer. 

Democrats urged their colleagues to extend the enhanced subsidies for at least another year to give Congress more time to address larger, more complex issues within the country’s health insurance and health care systems. 

Committee Chairman Mike Crapo, R-Idaho, said the hearing marked “the first step in building the foundation for” health care reform.

“We need both short-term and long-term solutions,” Crapo said. “In the short term, we cannot simply throw good money after bad policy. If we keep advancing a system that drives up premiums, we will make this problem even harder to solve.”

“Instead, we should set the groundwork for giving Americans more control over their health care choices,” Crapo added. “Rather than accepting the current system of giving billions of taxpayer dollars to insurers, we should consider providing financial assistance directly to consumers through health savings accounts, which are now available on the Obamacare exchanges through a provision in the One Big Beautiful Bill.”

Such tax-advantaged accounts are used to save money to pay for medical expenses and generally are used in conjunction with a high-deductible insurance plan, but an HSA “is a trust/custodial account and is not health insurance,” according to the Congressional Research Service.

The ACA, signed into law by President Barack Obama in 2010, overhauled the U.S. health care system with the intent of reducing high rates of uninsured people and ending insurance industry practices such as exclusions based on pre-existing conditions and the sale of policies with high costs and skimpy coverage. The law also expanded Medicaid and, for individual coverage, introduced the health insurance exchanges, or marketplaces, that now are at issue.

According to the health organization KFF, the number of uninsured Americans fell from about 14% to 16% in the years preceding passage of the law to a record low of 7.7% in 2023.

Pessimism about health care action

Oregon Sen. Ron Wyden, the top Democrat on the panel, rebuked Republicans for focusing on other policy areas throughout the year instead of making improvements to health care.

“Sitting on your hands has consequences,” he said. 

Wyden doesn’t see a way for Congress to extend the enhanced tax credits set to expire at the end of the year for people who get their health insurance from the ACA marketplace, despite Democrats pressing for that during the 43-day government shutdown that ended in mid-November. 

Wyden expressed support for working with Republican senators to address health insurance companies’ structure, though he said he is “skeptical” his GOP colleagues will actually approve legislation on that particular issue in the months ahead. 

“Now if they are serious about taking on the crooks that dominate big insurance, like UnitedHealthcare, I’m all in,” Wyden said. “In my view that starts with a laser focus on lower costs for consumers, going after fraud where it truly exists, and cracking down on middlemen.”

‘Very little that this Congress can do’

Douglas Holtz-Eakin, president at the center-right American Action Forum and former chief economist at the Council for Economic Advisers during the President George W. Bush administration, told the committee the structure of the Affordable Care Act poses problems. 

“As a piece of health policy, economic policy and budget policy, the ACA has always been a troubling construct,” Holtz-Eakin said, later adding there is “very little that this Congress can do to change the outlook” for 2026. 

Holtz-Eakin testified that Congress is long “overdue for a real rethinking of health care policy at the federal level” that he believes should focus on two primary areas. 

The first is to “rationalize the insurance subsidies” and the second is to address what he referred to as “high-value care,” which he said should include Medicare, the health program that covers 69 million Americans over 65 and some people with disabilities. 

“Medicare is a great budgetary threat, and so I encourage the committee and the Congress as a whole to take a hard look at that and make some progress toward better health care outcomes and better budgetary outcomes,” Holtz-Eakin said.  

Jason Levitis, senior fellow of the Health Policy Division at the left-leaning Urban Institute and a Treasury employee who led the ACA implementation at the department during the Obama administration, urged lawmakers to address the “too complicated and segmented” health insurance marketplace. 

Levitis said the best short-term option for Congress would be to extend the enhanced tax credits for ACA enrollees during 2026, despite the time crunch. 

“At this point the only feasible option is a clean extension of the existing enhancements,” Levitis said. “The marketplaces have already built that option and have been preparing for months for the possibility of an extension.” 

Former Trump adviser says ACA ‘failed’

Brian Blase, president of the Paragon Health Institute and a former special assistant to President Donald Trump at the White House National Economic Council, said bluntly that the Affordable Care Act has “failed.”

“The law entrenched an inefficient insurance-dominated health sector with massive subsidies flowing straight from the Treasury to health companies,” Blase said. 

The subsidies for ACA marketplace plans, he said, were “ill-designed and inflationary,” urging lawmakers not to extend them for another year.  

“The enrollee share of the premium is capped regardless of the total premium. When enrollees pay only a small slice of the premium or no premium at all, insurers face almost no price discipline,” Blase said. “Insurers can raise premiums knowing the taxpayers will absorb almost all of the increase.”

Blase said he believes the ACA’s regulations on health insurance companies are one of the reasons costs have spiked. 

“For example, under the medical loss ratio, insurers must spend a minimum share of premium revenue on medical claims. In other words, to increase profits, insurers must increase premiums,” Blase said. “The ACA’s essential health benefits require plans to cover the same set of services regardless of what people want or need. These rules increase premiums and wasteful spending.”

The medical loss ratio was included in the ACA in response to insurers who spent “a substantial portion” of premiums on administrative costs and profits, including executive salaries, overhead and marketing, according to the Centers for Medicare and Medicaid Services.

‘We all believe we need to reform’

Senate Majority Leader John Thune, R-S.D., told reporters separately from the hearing the debate over how to restructure health insurance to bring down costs has highlighted the “differences of opinion” among GOP lawmakers. 

“We’ve got a lot of people who have strong views, but the one thing that unites us is we all believe we need to reform, and we’ve got to do something to drive health care costs down,” Thune said. 

GOP leaders, he added, are “looking for solutions that will lower health care premiums, not increase them. And what we see today is just constant inflationary impacts from some of these policies of the past.”

Trump, who would need to support any health care overhaul bill for it to move through Congress, wrote in a social media post Tuesday that he wants lawmakers to send money straight to Americans, without detail on how that would work. 

“THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF AMERICA LONG ENOUGH,” Trump wrote. “THE PEOPLE WILL BE ALLOWED TO NEGOTIATE AND BUY THEIR OWN, MUCH BETTER, INSURANCE. POWER TO THE PEOPLE! Congress, do not waste your time and energy on anything else. This is the only way to have great Healthcare in America!!! GET IT DONE, NOW. President DJT”

Wisconsin Watch partners with Gigafact to produce fact briefs — bite-sized fact checks of trending claims. Read our methodology to learn how we check claims.

No.

The amount some pay for Affordable Care Act health insurance will double when enhanced subsidies expire, but there isn’t evidence the number is 20 million.

KFF, a health policy nonprofit, estimates monthly payments for Obamacare recipients will increase, on average, $1,016 – more than doubling, from $888 in 2025 to $1,904 in 2026.

That counts increases to premiums and lost subsidies.

U.S. Sen. Bernie Sanders, I-Vermont, citing KFF, made the 20 million claim. U.S. Sen. Ron Johnson, R-Wis., said Sanders was wrong.

KFF doesn’t say how many of the 24 million Obamacare enrollees will see premiums double.

But 2 to 3 million people on the high end of income eligibility would lose all enhanced subsidies. About half could see premium payments double or triple. 

Enhanced subsidies, created in 2021, expire Dec. 31. Some Obamacare enrollees will receive lower enhanced subsidies or none. Standard subsidies remain.

This fact brief is responsive to conversations such as this one.

Sources

• KFF: ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire
• U.S. Sen. Bernie Sanders: Email
• KFF: Email
• Centers for Medicare & Medicaid Services: Health Insurance Exchanges 2025 Open Enrollment Report
• The Journalist's Resource: The battle over Affordable Care Act insurance subsidies: What to know as open enrollment looms
• NBC News: What the government shutdown's end means for Obamacare subsidies
• PolitiFact: Fact-checking Democrats’ talking points about Affordable Care Act subsidies

Will 2026 Obamacare premiums double for 20 million Americans? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Wisconsin Watch partners with Gigafact to produce fact briefs — bite-sized fact checks of trending claims. Read our methodology to learn how we check claims.

Yes.

Affordable Care Act premiums, expected to skyrocket in 2026 unless enhanced subsidies are extended, have increased about 118% since coverage for individuals began in 2014.

That’s three times higher than inflation (39%).

U.S. Sen. Ron Johnson, R-Wis., made the three-times claim Oct. 21, as the federal government shutdown continued. 

To end the shutdown, Democrats want to extend the enhanced Obamacare subsidies, which made more people eligible. They expire Dec. 31. 

Without enhanced subsidies, Wisconsinites could see 2026 premium increases of up to 800%, according to the state. 

The average monthly premium for a benchmark Obamacare plan was $273 in 2014; it is expected to be at least $596 in 2026.

Premiums, initially so low that insurers lost money, jumped in 2017, stayed stable since 2018 but are expected to rise more than 18% in 2026, KFF Obamacare program director Cynthia Cox said.

This fact brief is responsive to conversations such as this one.

Sources

• U.S. Bureau of Labor Statistics: CPI Inflation Calculator
• The Journalist's Resource: The battle over Affordable Care Act insurance subsidies: What to know as open enrollment looms
• Wisconsin Gov. Tony Evers: Healthcare Premiums for Wisconsinites to Skyrocket in 2026 if Republicans Fail to Extend Affordable Care Act Tax Credits
• KFF: Marketplace Average Benchmark Premiums
• Peterson-KFF: How much and why ACA Marketplace premiums are going up in 2026

Have Obamacare premiums increased three times the rate of inflation? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Gov. Tony Evers, shown here in a press gaggle in March, said Monday that health insurance rates on the ACA market are set to skyrocket in Wisconsin. (Photo by Baylor Spears/Wisconsin Examiner)

Last updated 10/28/2025, 1:51 p.m. 

The cost for health care coverage purchased on HealthCare.gov in Wisconsin will rise for some insurance policies by anywhere from 45% to 800% for 2026, depending on where a person lives, Gov. Tony Evers announced Monday.

The increased rates will be made worse with the end of enhanced federal subsidies, provided in the form of tax credits, that have lowered insurance costs through the marketplace since 2021, Evers and Sen. Tammy Baldwin (D-Wisconsin) said during a virtual press conference Monday morning. The enhanced subsidies expire at the end of December.

“In 2025, 88% of Wisconsinites [who] enrolled in coverage on HealthCare.gov qualify for tax credits, saving an average of $664 a month,” Evers said. “And without these enhanced tax credits, health care premiums for Wisconsinites are going to skyrocket, period. Many Wisconsinites will see their premiums double, and some of them will see staggering increases.”

HealthCare.gov is the federal insurance marketplace, created under the 2010 Affordable Care Act (ACA) to improve health insurance access for people without health coverage from an employer or from government programs.

More than 310,000 Wisconsinites purchased health insurance through the marketplace for 2025, according to the Wisconsin Office of the Commissioner of Insurance (OCI). HealthCare.gov open enrollment for 2026 starts Nov. 1.  

OCI released a list Monday with examples of rate increases for patients of various ages and under selected scenarios based on age, family size and incomes. The examples compared rate increases across eight counties.

Evers said a statewide average increase wasn’t available “because it’s going to impact lots of people in a lot of different ways.”

The comparisons made by OCI all reflected health plans in the Silver category on HealthCare.gov. Silver plans have a “moderate” deductible and require patients to pay 30% of the cost of care (see sidebar, HealthCare.gov insurance plan categories).

In a few scenarios and locations, rate increases will be lower than 10%. Those are exceptions, however. Most scenarios and locations showed premium increases ranging from more than 30% on up. Some increases were well over 100%, and one example showed an increase of more than 800% in one county.

The comparisons reflect the premium cost after any subsidies are applied. 

The ACA included subsidies on the cost of insurance from the beginning for people with incomes up to 400% of the federal poverty guideline.

The enhancements that were put in place in 2021 and expire at the end of December included increases in the subsidies for the original group. They also extended subsidies to people with incomes above 400% of the poverty guideline, to avoid an “eligibility cliff” at those higher incomes. 

In the comparisons, the 2025 premiums include the effect of the enhanced subsidies, while the 2026 premiums reflect the return to the original subsidy formula.

According to OCI’s report 2026 premiums will increase:

• Between 39% in Waukesha County and 85% in Barron County for a 26-year-old with an income of $48,000 (subsidy continues, but reduced).
• Between 16% in Marathon County and 43% in Barron County for a 26-year-old with an income of $65,000 (subsidy ended).
• Between 18% in Brown County and 84% in Barron County for a 40-year-old with an income of $65,000  (subsidy ended).
• Between 132% in Waukesha County and 391% in Barron County for a 60-year-old with an income of $63,383  (subsidy ended).
• Between 221% in Waukesha County and 812% in Barron County for a 60-year-old couple with an income of $85,658  (subsidy ended).
• Between 2% in Waukesha County and 57% in Barron County for a family  of four with a household income of $128,000 (subsidy continues, but reduced).
• Between 102% in both Waukesha and Dane counties and 312% in Barron County for a family of four with a household income of $130,000  (subsidy ended).

In both family examples, the parents are ages 48 and 47 and children ages 8 and 12.

Nationwide, some 22 million Americans will see their premiums double on average, Baldwin said. She cited projections that 4 million Americans “will look at that price tag and decide to drop their insurance altogether because it’s simply too expensive. It’s more than they can afford.”

KFF, a nonpartisan, nonprofit health policy news and analysis organization, reported Oct. 3 that seven out of 10 people nationally who buy health coverage through the federal marketplace said they would not be able to afford insurance without the enhanced subsidies.

Democrats in Congress have named extending the subsidies as one of their conditions for Democratic support of the Republican majority’s legislation to end the current federal shutdown.

In response, GOP leaders in Congress have called on Democratic lawmakers to sign on to their spending bill to restart the government and then negotiate to extend the subsidies.

Baldwin said Democrats won’t accept “a wink and a nod” that the tax credit talks should come after the government reopens. She said she’s heard privately from Republicans in the Senate who agree that Congress should extend the subsidies.

With 78% of Americans, according to one poll, “who believe we need to address this, and many of my Republican colleagues want to do so, then we need to have an agreement to extend the tax credits as we reopen the government,” Baldwin said.

Later Monday in Milwaukee, Evers held a round table with business owners, advocates and lawmakers to discuss the HealthCare.gov rate increases.

“If you’re seeing these jumps in 26-year-olds, across the board, I don’t know how we afford this,” said Dan Jacobs, owner of the Milwaukee restaurant DanDan. Jacobs said about two-thirds of his employees have health insurance, most of them probably purchasing it through the marketplace.

His business subsidized the insurance premiums that full-time employees and managers bought through HealthCare.gov for 2025, he said, but with the premium increases, reported Monday, “we’re not going to be able to afford to do that,” Jacobs told Evers.

Kara Pitt-D’Andrea, who operates a nonprofit child care facility in Milwaukee with about 25 employees, told Evers,  “100% of us are on the ACA or Medicaid.” 

She called health coverage a moral imperative rather than an act of charity. “To say to people, ‘We refuse to come to the table to create a sustainable option for you’ is the equivalent of saying, ‘You are unimportant in the game of business that we are playing,’” Pitt-D’Andrea said.

Wisconsin Watch partners with Gigafact to produce fact briefs — bite-sized fact checks of trending claims. Read our methodology to learn how we check claims.

No.

We found no documentation confirming a Sept. 29 statement by U.S. Sen. Ron Johnson, R-Wis., that 6 million people unknowingly received health insurance through the Affordable Care Act.

Johnson cited a report by Paragon Health Institute, a think tank aligned with the Trump administration. 

The report produced an estimate, not a count, claiming 6.4 million people were fraudulently enrolled in Obamacare. It said they were not income-eligible, including millions who “appear to be enrolled without their knowledge.”

The methodology was faulted by Blue Cross Blue Shield, the National Association of Benefits and Insurance Professionals and the American Hospital Association. 

Paragon stood by its work.

Fraud is much more common among brokers misappropriating patients’ identities than by patients, said KFF Obamacare program director Cynthia Cox and Justin Giovannelli of Georgetown University’s Center on Health Insurance Reforms.

Consumers are cautioned about offers to enroll them in Obamacare.

This fact brief is responsive to conversations such as this one.

Sources

• U.S. Sen. Ron Johnson: Email
• Paragon Health Institute: The Greater Obamacare Enrollment Fraud: The Fraud Got Much Worse in 2025
• Politico: The think tank driving health policy on Capitol Hill — and dividing Republicans
• Washington Post: As GOP eyes ACA cuts, a conservative group highlights rampant fraud
• Paragon Health Institute: Answering the Critics: How Paragon Discovered Enrollment Fraud in the ACA Exchanges
• Blue Cross Blue Shield: The facts about the individual marketplace
• National Association of Benefits and Insurance Professionals: Facts Over Fear: NABIP Rebukes Paragon’s Misleading ACA Claims
• American Hospital Association: Setting the Record Straight: Separating Fact from Fiction on Health Insurance Marketplace Fraud
• U.S. Department of Health and Human Services: Consumer Fraud in the Health Insurance Marketplace

Do 6 million people receive Obamacare health insurance without knowing it? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

An Afghan refugee caresses her 9-day-old infant inside the pediatric ward of a medical treatment facility in 2021 at Joint Base McGuire-Dix-Lakehurst, N.J. Refugees are among the lawfully present noncitizens facing the loss of federally funded health care coverage. (Photo by Barbara Davidson/Pool/Getty Images)

An estimated 1.4 million immigrants who are in the country legally but are not citizens stand to lose their government-subsidized health care coverage under the sweeping tax and spending bill President Donald Trump signed into law this summer, according to estimates from the nonpartisan Congressional Budget Office.

The One Big Beautiful Bill Act cuts federal spending on Medicaid, the joint federal-state health insurance program for low-income people. It also places new eligibility restrictions on lawfully present immigrants, including refugees and asylees, who are enrolled in a variety of government-subsidized health programs: Medicaid, the Children’s Health Insurance Program (CHIP), Medicare and Affordable Care Act marketplaces.

Immigrants who are in the country illegally have long been ineligible for federally funded health coverage.

But seven states — California, Colorado, Illinois, Minnesota, New York, Oregon and Washington — plus the District of Columbia have extended state-funded coverage to some income-eligible noncitizen adults regardless of their immigration status. Fourteen states plus the district provide state-funded coverage to noncitizen children whether they are here legally or not.

The new restrictions in the One Big Beautiful Bill Act, combined with other Trump policies limiting public benefits for immigrants, put those states in a financial bind. With less federal money to provide health benefits to immigrants who are here legally, states will be hard-pressed to maintain their programs that offer coverage to all immigrants, regardless of their legal status.

“We’re taking a giant step backwards from that public health and preventive health measure by excluding more people and draining federal resources from states that need it,” said Tanya Broder, a senior counsel specializing in immigrant health policy at the National Immigration Law Center, an advocacy group.

“And the result will be that our health — individually, as families and as communities — will be in jeopardy, and the health care infrastructure that serves all of us will also be compromised,” Broder said.

Already, some states that had offered health coverage aid to all immigrants — regardless of status — have been pulling back.

To help close a $12 billion deficit, California Democratic Gov. Gavin Newsom in June signed a state budget that bars immigrants who are here illegally from enrolling in the state’s Medicaid program, known as Medi-Cal. Current enrollees between the ages of 19 and 59 will have to pay a new $30 monthly premium beginning in 2027. In July 2026, the state will eliminate dental care for noncitizens.

Illinois in July ended its state-funded health coverage program for all immigrants ages 42 to 64. The state still operates a state-funded plan for residents 65 and older regardless of immigration status, but enrollment has been paused. And Minnesota also plans to exclude adult immigrants who are here illegally from a program that used to provide coverage regardless of immigration status.

New York is in an especially tough spot, since its state constitution prohibits discrimination against lawfully present immigrants in providing public benefits.

“States have had some type of leeway to fund resources for migrant communities if they want to,” said Medha Makhlouf, a law professor and the founding director of the Medical-Legal Partnership Clinic at Penn State Dickinson Law who studies immigrants’ access to health care. “But now this [federal] law makes it difficult for them to do that.”

Making it less attractive to stay

Jessica Vaughan, director of policy studies at the Center for Immigration Studies, a nonprofit group that backs stricter immigration policies, said these efforts are part of both Trump’s larger anti-immigration stance and “Congress’ interest in getting rid of any incentive or benefit for people who are in the country illegally.”

“It’s a way of making it less attractive for people to stay here illegally, right?” Vaughan said. “They’re trying to give people reasons to leave rather than reasons to stay.”

As noncitizens who are here legally lose access to federally funded benefits, the demand for state-funded coverage is “likely to increase,” Drishti Pillai, director of immigrant health policy at KFF, a health policy research group, told Stateline.

“However, at the same time, states are facing increasing budget pressures, especially with the Medicaid cuts,” Pillai said. “So it’s almost a double whammy, where there will likely be increased demand for state-funded coverage programs, but also states will have fewer resources to cover people.”

Makhlouf said the Trump administration’s policy changes reflect a broader strategy of stripping public benefits from marginalized and poor communities.

“Everyone who cares about access to health care needs to pay attention to what’s happening to immigrants,” she said. “When it becomes normalized to be able to sacrifice certain people’s humanity or their vulnerability, or to minimize their contributions to society, and say, ‘You don’t deserve access to health care,’ then that can be turned on to any group.”

Under Trump’s domestic policy law, California expects to lose at least $28.4 billion in federal Medicaid funding, according to Newsom’s office.

On the California Senate floor June 27, Democratic state Sen. María Elena Durazo expressed her sorrow at the state’s decision to deny coverage to immigrants.

“I can’t express how much joy I felt when we expanded basic health care,” Durazo said. “Today, that joy that I was so happy about, that joy has turned into pain, that joy has turned into shame.”

Democratic Senate Pro Tem Mike McGuire, however, said the state had little choice.

“We are a state of immigrants, 10.6 million strong. And we will never turn our backs on those who are part of the heart of the largest economy in the United States of America,” McGuire said during the debate. “So we’ve had to make some tough decisions. I know we’re not going to please everyone.”

Obligated in New York

One state, New York, is particularly in a bind, because its constitution requires it to provide coverage to lawfully present noncitizens.

Roxana, 27, has been living in the U.S. under the Deferred Action for Childhood Arrivals program, known as DACA, since she was 8 years old and is using her first name only out of fear she will be targeted. At the end of 2019, she experienced a range of debilitating symptoms, including pelvic pain and chronic fatigue, and discovered a noncancerous lump on her breast.

“Chronic illness has impacted my career trajectory with a lot of fatigue and chronic pain,” said Roxana, who lives in the Bronx, New York.

Roxana cannot get federally funded Medicaid. But she qualified for state-funded public health coverage in New York. A 2001 court case, Aliessa v. Novello, requires the state to offer publicly funded health coverage to all lawfully present residents under the state constitution. So, she could afford to go to the doctor, where she learned that she had a hormonal condition called polycystic ovary syndrome, or PCOS, and she was able to get the lump removed.

New York mostly picked up the tab for immigrants and other lawfully residing immigrants until 2016, when it launched coverage it called the Essential Plan under the 2010 Affordable Care Act, also known as Obamacare. Under the ACA, the plan has no deductibles or monthly premiums for patients, and the federal government has picked up almost the entire cost — 90% — of the plan, a huge economic relief for the state.

Now, New York faces an annual loss of $13.5 billion in federal Medicaid and Affordable Care Act funds. Additionally, the phasing out of premium tax credits for noncitizens under Trump’s law would lead to a loss of $7.5 billion in annual funding to the state’s Essential Plan, which covers 1.7 million New Yorkers.

“These are billions of dollars that are being taken away and out of New York’s delivery system,” Amir Bassiri, director of Medicaid at the New York State Department of Health, said at a United Hospital Fund conference on July 30.

It’s unclear whether and how the state will afford to cover people like Roxana, even though it’s required under the state’s constitution. Like other immigrants, she is terrified that in the face of cuts and shrinking safety net access for noncitizens, she will lose continuous health care coverage and that her condition will get worse.

“My PCOS symptoms have just been getting worse over the years. I really want to try my best with the health access that I have to get it under control.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

The U.S. Capitol on the evening of Tuesday, Sept. 30, 2025, just hours before a federal government shutdown. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — U.S. Senate Democrats and Republicans remained at a stalemate Wednesday as government offices closed and hundreds of thousands of federal workers faced furloughs on the first day of a government shutdown that showed no sign of ending.

Proposals from each side of the aisle to fund and reopen the government failed again during morning Senate votes, mirroring the same vote breakdowns as Tuesday evening, when lawmakers could not reach a deal hours before the government ran out of money.

The nonpartisan Congressional Budget Office projected up to 750,000 federal workers could be furloughed, leading to a $400 million per day impact on the economy.

Locked in their positions, Republicans failed to pick up enough Democrats to reach the 60 votes needed to advance their plan to fund the government until Nov. 21. 

Senators will break Thursday to observe Yom Kippur but will return Friday to again vote on the funding proposals.

Democratic Sens. Catherine Cortez Masto of Nevada and John Fetterman of Pennsylvania, along with independent Angus King of Maine, again joined Republicans in the 55-45 vote for the House-passed stopgap spending bill. GOP Sen. Rand Paul of Kentucky voted no.

Democrats also failed to find support to move forward their bill to fund the government through Oct. 31, roll back GOP cuts on Medicaid and permanently extend subsidies that tie the cost of Affordable  Care Act health insurance premiums to an enrollee’s income level. 

The Democrats failed to advance their plan in a party-line 47-53 vote. King, who caucuses with Democrats, voted in favor.

Shutdown tied to health care tax credits

Senate and House Democrats say they will not support a GOP path to reopen the government unless Republicans agree to negotiate on rising health care costs. 

House Minority Leader Hakeem Jeffries said at a press conference that Democrats are “ready to sit down with anyone at any time and at any place in order now to reopen the government, to enact a spending agreement that meets the needs of the American people and to address the devastating Republican health care crisis that has caused extraordinary harm on people all across the country.”

The New York Democrat pointed to harms in “rural America, working class America, urban America, small-town America, the heartland of America and Black and brown communities throughout America.” 

Democratic leaders blitzed Capitol Hill with their message on health care, holding press conferences and attending an evening rally Tuesday on the lawn outside the U.S. House. 

They pointed to new data published this week showing annual insurance premiums could double on average in 2026 if the subsidies expire at year’s end, according to an analysis from the nonprofit health policy research organization KFF. 

Open enrollment for next year’s ACA health insurance plans opens Nov. 1 in most states, and Oct. 15 in Idaho.

Uptake of ACA health insurance plans has more than doubled to over 24 million, up from 11 million, since the introduction of the subsidies in 2021, according to KFF. 

During their own budget reconciliation deal in 2022, Democrats extended the insurance premium tax credits until the end of 2025. The majority of ACA enrollees currently rely on the credits.

Democrats also want assurances that the White House and Senate Republicans will not cancel any more funds that have already been approved by Congress, as was the case this year when the administration and GOP lawmakers stripped funding for medical research, foreign aid and public broadcasting, among other areas.

‘This can all end today’

GOP leaders in the House and Senate continued to blame Senate Democrats for the government shutdown at the expense of furloughed federal workers and Americans who rely on their services. 

At a Wednesday morning press conference, House Speaker Mike Johnson said “troops and border patrol agents will have to go to work, but they’ll be working without pay.”

Johnson also claimed at the press conference that veterans benefits would stop. The claim is false, as Veterans Administration medical care will continue uninterrupted and vets will also continue to receive benefits, including compensation, pension, education and housing.

“As we speak here this morning, there are hundreds of thousands of federal workers who are getting their furlough notices. Nearly half of our civilian workforce is being sent home — these are hard-working Americans who work for our federal government,” the Louisiana Republican said, flanked by fellow GOP leaders on the Upper West Terrace of the U.S. Capitol overlooking the National Mall. 

Johnson decided in late September the House will be out until Oct. 6, canceling this week’s votes. 

The speaker said he will bring House members back next week, even if the government is still shut down.

“They would be here this week, except that we did our work — we passed the bill almost two weeks ago out of the House, sent it to the Senate,” Johnson said. “The ball is literally in (Senate Minority Leader) Chuck Schumer’s court, so he determines that.” 

Senate Majority Leader John Thune said “this can all end today” and “needs to end today.”

The South Dakota Republican said the funding lapse can cease when Senate Democrats vote for the GOP’s “clean” short-term funding bill. 

“We will continue to work together with our House counterparts, with the president of the United States, to get this government open again on behalf of the American people,” Thune said. 

Bipartisan deal and Trump

Virginia Democratic Sen. Tim Kaine said later in the day that a bipartisan group huddled on the floor during votes to talk about a possible path forward on “health care fixes” and ensuring that if a bipartisan deal is brokered, the Trump administration will stick to it. 

Republican senators, he said, could give Democrats assurances they won’t vote for any more rescissions requests from the White House, which ask Congress to cancel already approved government spending. But other issues, like laying off federal workers by the hundreds or thousands, have to be a promise from the president. 

“If I find a deal, should Congress have to follow it? Yes. Should the president have to follow it? Yes. Well, what if the president won’t follow it? Oh, yeah, you got a problem,” Kaine said. “So you know, rescission, impoundment, those are Senate words. But a deal is a deal — people get that.”

Kaine also emphasized that it’s not a “clean” stopgap funding bill if the Trump administration unilaterally cancels some of the spending. 

“In the past, we voted for clean (continuing resolutions), but the president has shown that he’ll take the money back,” Kaine said, referring to the technical name for a short-term funding bill. “I mean, just in Virginia, canceling $400 million to our public health, $40 million economic projects just pulled off the table, firing more Virginians than any president. 

“So we just want you to agree, if we do a deal, then you’ll honor the deal,” Kaine said. “It’s not that much to ask.”

‘People are suffering’

North Carolina Republican Sen. Thom Tillis said he doesn’t expect the shutdown will have long-term ramifications for senators’ ability to negotiate bipartisan deals — a necessity in the upper chamber, which has a 60-vote threshold to advance legislation. 

“It’s all transactional,” Tillis said. “I think there’s going to be opportunities for some bipartisan work, but none of that happens, you can’t even really consider it when you’re in a shutdown posture.”

Cortez Masto, who voted to advance Republicans’ seven-week stopgap bill, said the GOP “created this crisis” on health care and “need to address it.”

“They have no moral standing — no moral standing —- to say that this is all on the Democrats. They are in control. They’ve created this crisis,” Cortez Masto said. “People are suffering and they need to come to the table.” 

Missouri Republican Sen. Josh Hawley, who was sworn in for the first time during the last shutdown, said he worries about longer-term effects. 

“My concern is it’s going to poison the well on negotiations going forward on a lot of things,” Hawley said. “I can’t speak for anybody but myself, but I would just say that these tactics are very destructive. And it’s destructive, not just for relationships, but for real people.”

Ariana Figueroa contributed to this report.

Rachel LaCasse-Ford, right talks to Sen. Tammy Baldwin about her use of the Affordable Care Act marketplace to buy insurance during a meeting Baldwin held with small business owners and others in Mount Horeb, Wisconsin, on Sept. 25. (Photo by Erik Gunn/Wisconsin Examiner)

Matt Raboin owns Brix Cider, a farm-to-table restaurant, and brews apple cider in the Dane County village of Mount Horeb.

His wife’s full-time job with benefits provides the family with health insurance, but for Raboin, the Affordable Care Act (ACA) has made an important difference for some of his employees.

“We don’t offer insurance ourselves,” Raboin said during a recent round table discussion set up by Sen. Tammy Baldwin (D-Wisconsin). “A lot of small businesses in small towns aren’t in a financial place to do that.”

Like Raboin, some of his employees get their coverage through a spouse or because they also work another full-time job that provides benefits. But over the years, the ACA and the HealthCare.gov marketplace created under the law have been a critical source of health coverage for many of his employees, Raboin said.

Recently he polled a number of them. One memorable response came from a part-time employee who also has a part-time job with a local church. She buys her health insurance on HealthCare.gov. Thanks to an increase enacted in 2021 in tax credit subsidies, she’s been able to afford the premiums, Raboin said she told him.

“So without it, she’s like, ‘I can’t keep working for you. And I don’t think I keep working for my church. I think I have to find a different job,’” Raboin recalled.

The ACA and HealthCare.gov have made it possible for millions more Americans and thousands more Wisconsin residents to obtain health insurance.

But less visibly, the health care marketplace that the ACA created has also helped support many small businesses. If the enhanced tax credit subsidies that lowered the cost of health insurance for millions over the last three years aren’t renewed, small business owners and employees say they could be especially hard hit.

Nearly half of people who get their health insurance through the HealthCare.gov marketplace are self-employed or small business owners, or else work for small businesses, according to KFF, an independent nonprofit that researches and reports on health policy.

To expand access to health care, the ACA created the HealthCare.gov marketplace to make buying health insurance easier for people whose jobs don’t provide coverage and who don’t qualify for government programs such as Medicaid.

To make coverage more affordable, the law provides tax credit subsidies for people with incomes up to 400% of the federal poverty guideline. Those subsidies were increased in 2021 and expanded to people with higher incomes.

The enhanced subsidies will expire at the end of 2025 unless Congress extends them — driving up the cost of health insurance for millions.

The enhanced subsidy “saves more than 230,000 Wisconsinites an average of $500 every single month,” Baldwin said during a Zoom press conference Tuesday.

For Chrysa Ostenso and her late husband, the enhanced subsidies lowered their premiums from nearly $2,000 a month to about $300 a month, Ostenso said.

Ostenso lives in Ladysmith, Wisconsin, where she and her husband operated an optometry clinic for more than three decades, raising four children along the way.

“We always struggled to afford health insurance but of course we had to buy it,” Ostenso said in an interview. “As a family of four kids with a small business, you can’t go without health insurance.”

The family’s high deductible plans required them to pay $6,000 a year out of pocket before insurance would cover their health care. By 2020, when the children were grown and the health plan just covered Ostenso and her husband, they were paying $1,979 a month, she said.

They hadn’t qualified for the original ACA subsidies. When the enhanced subsidies were enacted in 2021, however, Ostenso said their premiums went down to $300 a month, increasing to $500 a month in subsequent years.

“It actually meant freedom to go to the doctor, because we were spending so much money on our premiums [previously] that we actually couldn’t afford to go to the doctor,” she said.

Standoff over extending subsidies

In the weeks leading up to Tuesday night’s federal shutdown, Democrats in Congress demanded that Republicans rescind sweeping changes to Medicaid that were part of the major tax- and spending-cuts megabill that President Donald Trump signed July 4.

They also demanded an extension of the enhanced ACA subsidies.

Baldwin has coauthored legislation that would make the enhanced subsidies permanent. She spent part of the just-concluded congressional recess traveling Wisconsin and meeting with people who expect to see their health costs go up sharply if the increased subsidies end.

During Tuesday’s press conference, Baldwin related a conversation with a  bakery owner who worried about how she and her family will afford health insurance, “but also that increased costs on the [HealthCare.gov] exchange will mean that her employees at her bakery may have to quit to work for big companies that offer insurance.”

During Baldwin’s press conference, Gigi Gastevich, an artist who owns a retail space in Stoughton, said the ACA and the enhanced subsidies had made it possible for her to launch and grow her business.

Gastevich is a 15-year cancer survivor. When starting her business, she qualified for BadgerCare — Wisconsin’s main Medicaid program — which covered the ongoing medical monitoring she requires as a cancer survivor.

In 2025, with her income above the limit for BadgerCare, she found an insurance plan on HealthCare.gov that included her existing health care professionals in its network and had an affordable deductible.

The plan’s premium was $481 a month, Gastevich said, but the enhanced subsidy  brought it down to about $100 a month.

Without the subsidy, she said, she will have to switch plans — possibly losing her long-standing group of providers if they aren’t in the network. She said her choices include taking a high-deductible plan that would put some of the regular care she’s been recommended as a cancer survivor out of reach financially; or closing down her business. 

“[That] would mean not only abandoning my dream of entrepreneurship and being a self-employed artist, but taking away an income source for the dozens of artists and artisans whose American-made work I sell here,” Gastevich said.

It would also forestall her plans to scale up her business to sell her own line of textiles and employ others. “I won’t be able to do that if my health and well-being is tied to being on an employer-based health care plan,” she added.

Uncertain future

During her tour of the state, Baldwin stopped in Mount Horeb on Thursday, Sept. 25, where she spoke with Brix owner Matt Raboin and four other business owners as well as local health care providers.

The round table took place at the Upland Hills Health Mount Horeb clinic. The urgent care clinic is part of a broader system that includes a hospital in Dodgeville and clinics in surrounding communities.

Dr. Mark Thompson, Upland Hills CEO, said system executives expect to see about $400,000 a year in additional uncompensated care based on projections of people leaving the insurance rolls because they don’t think they can afford the new ACA premiums.

Jay Goninen sat in as a board member of the Upland Hills system, but he’s also an employer for whom the ACA has made it possible to provide health benefits.

Goninen owns a business that helps connect the auto repair industry with high schools and technical schools. For the last few years, he’s opted to have employees of the firm purchase health insurance on the ACA.

The company pays a portion of the cost. Goninen likens the arrangement to a common practice of employers who offer a group health plan and split the cost with their employees.

“I do really worry about just the individual person and their ability to afford to live right now, in general,” he told Baldwin. “It is tough.”

In addition to worrying about what will happen to employees who bought coverage at HealthCare.gov if they lose their subsidies, Raboin said he’s also concerned about the broader ripple effect in the community.

“Our clients aren’t rich,” Raboin said. “Not everybody can go out to eat all the time, and if you start taking away that expendable income, that’s less people coming out to eat. So I think it would depress the whole economy.”

Rachel LaCasse-Ford owns a campground with her husband and also heads the Mount Horeb Chamber of Commerce.

“I’ve never really had a job that offers health care,” LaCasse-Ford told Baldwin. “I’ve always worked in small business, so we have always used health care from the ACA.”

The enhanced tax credits “definitely benefited” the couple, she said. “And if those go away, that will make our budgets tighter, and it will make things more challenging for us.”

With every new job, LaCasse-Ford said, she considers its impact on their health coverage and whether she can stay with a nonprofit employer such as the chamber, work for a small business, “or if I need to look for a larger employer that offers benefits.”

Senate Minority Leader Chuck Schumer, left, and House Minority Leader Hakeem Jeffries, both New York Democrats, speak to reporters Sept. 29, 2025, at the U.S. Capitol in Washington, D.C. (Photo by Shauneen Miranda/States Newsroom)

WASHINGTON — Democratic and Republican lawmakers remained far apart Monday with just over 24 hours until a federal government shutdown begins, after a White House meeting with President Donald Trump and congressional leaders meant to spur negotiations.

Senate Majority Leader John Thune, House Speaker Mike Johnson, Senate Minority Leader Chuck Schumer and House Minority Leader Hakeem Jeffries emerged from the White House just after 4:30 p.m. Eastern still entrenched in their positions. 

Democrats are demanding promises to lower rising health care costs, and Republicans are pushing for a “clean” stopgap bill to keep the government running through mid-November.

Schumer said he believed “for the first time the president heard our objections,” but “large differences” remained.

“It is our job as legislative leaders to try and solve this problem, or at least fix the problem, and we focused in the room in particular on the (Affordable Care Act) and its extension,” Schumer, a New York Democrat, told reporters on Capitol Hill a short time later.

Vice President JD Vance, flanked by Thune, Johnson and Office of Management and Budget Director Russ Vought, separately told reporters outside the White House, “We’re headed to a shutdown.”

“If they want to talk about how to fix American health care policy, let’s do it. The speaker would love to do it. The Senate majority leader would love to do it. Let’s work on it together, but let’s do it in the context of an open government that’s providing essential services to the American people,” Vance said.

Government funding runs out at midnight Tuesday. If no compromise is reached, hundreds of thousands of government employees would be furloughed, while many would be required to keep working without pay. States Newsroom published a guide explaining what happens.

Health care premium increases

Democrats point the finger to changes made in the recent tax and spending cuts law — commonly referred to as the “one big beautiful bill” — as the reason for rising health care costs.

The law allows enhanced premium tax credits for those who use health insurance on the government marketplace to expire as previously scheduled, by Democrats in an earlier law, at the end of 2025. Republican lawmakers also cut roughly $1 trillion in Medicaid funding over the next decade to help account for the law’s extended and new tax cuts.

“We’re deadly serious about addressing the Republican-caused health care crisis, because it’s a deadly serious issue for the American people — the largest cut to Medicaid in American history, hospitals, nursing homes and community-based health funding closing right now,” Jeffries, also a New York Democrat, said.

Health insurance companies on the Affordable Care Act marketplace have requested or finalized price increases of at least 20% in 29 states, according to an analysis released Thursday by U.S. Sen. Maria Cantwell, a Washington state Democrat.

All marketplace insurer rate increase requests are publicly available at healthcare.gov.

Schumer also pointed to the Trump administration’s impoundment and GOP lawmakers’ rescissions of federal funds, including those for medical research, foreign aid and public media, as another hard line for Democrats.

“We made the point clear that how could we negotiate a bipartisan agreement and then have the president unilaterally through impoundment, or the Republican Party through rescissions, and the president unilaterally through pocket rescissions, undo it all without any input,” Schumer said.

GOP slams ‘hostage-taking’ in shutdown

Republican leaders accused Democrats of “hostage-taking,” and pointed to a five-year, $50 billion fund for rural hospitals that was tucked at the eleventh hour into the massive tax and spending cuts package to compensate for health care cuts.

Thune raised in his hand the GOP’s temporary funding bill that would keep the government open until Nov. 21 and said he didn’t understand why Democrats are “saying this is some huge partisan thing.”

“This is something we do fairly routinely,” Thune, of South Dakota, said of temporary stopgap funding bills. 

“This is purely and simply hostage-taking on behalf of the Democrats,” he added.

Johnson said the House had “done its job” roughly two weeks ago when all Republicans and one Democrat passed the seven-week stopgap funding bill. 

“That is the record, and don’t forget it,” the Louisiana Republican said.

Republicans failed to gain enough Democratic votes in the Senate, which they control with 53 seats, to clear the final hurdle of 60 votes to advance legislation. Two Republican senators, Alaska’s Lisa Murkowski and Kentucky’s Rand Paul, also voted against the measure.

Jennifer Shutt and Shauneen Miranda contributed to this story.