Democrats and Republicans have sparred over Democratic demands to address health care issues in a government funding bill, with the standoff leading to the first government shutdown since 2019. We’ll provide the facts on two talking points each side is using to blame the other for the shutdown.
- Democrats have repeatedly said that health care premiums will rise 75% without action from Republicans, a figure that needs context. That’s an estimate for the average increase in out-of-pocket costs for those getting Affordable Care Act subsidies to buy insurance — if enhanced subsidies expire at the end of this year as scheduled.
- Republican leaders have misleadingly said that Democrats “demand we fund healthcare for illegal aliens.” The Democrats have proposed restoring health care for “lawfully present” immigrants, but not for immigrants living in the country illegally, who are prohibited by law from receiving federally funded coverage.
Democrats maintained that legislation to continue funding the federal government should include an extension of the more generous ACA subsidies, which were first enacted in 2021, and a repeal of some health care measures affecting Medicaid in the One Big Beautiful Bill Act. Republicans rejected that proposal, saying that the enhanced ACA subsidies could be discussed later, after a bill to extend current funding levels was passed. With the two sides at a stalemate — and each side needing several votes from the other party to pass any measure — the government shut down on Oct. 1
75% Increase
Democrats have repeatedly claimed that without actions from their Republican colleagues in Congress, health care premiums will spike, citing a “75% increase.” It’s not always clear that Democrats are talking about an average out-of-pocket increase for those who obtained health insurance through the ACA marketplaces — an increase caused by the expiration of expanded tax credits enacted in 2021.
Democrats want an extension of those enhanced subsidies. The Congressional Budget Office estimated that making the more generous tax credits permanent would cost $335 billion over 10 years.
On CBS’ “Face the Nation” on Sept. 28, Democratic Sen. Amy Klobuchar said, “My constituents, Americans, are standing on a cliff right now with these insurance premium increases that are upon them. So, Democrats are united in pushing on this and saying, look, let us do something about this crisis before it is too late, 75% increase in premiums starting Nov. 1 on people who are small-business owners, people who are farmers out there, twice as much in the rural areas.”
Host Margaret Brennan then added: “You’re talking about the extension of the health care subsidies.”
In a post on X, Independent Sen. Bernie Sanders said, “This government shut down is all about whether Republicans will get away with raising health care premiums by 75% for 20 million Americans and throwing 15 million people off their health care.”
Other Democrats have similarly cited the 75% figure.
The figure is the average increase in out-of-pocket premium costs, if the enhanced subsidies are allowed to expire, for consumers receiving subsidies for coverage purchased through the ACA marketplaces. It comes from an estimate by the health policy research organization KFF, which has said that “in 2024, out-of-pocket premium payments among subsidized enrollees would have been over 75% higher without the enhanced tax credits.”
More specifically, KFF estimated that in 2024, the average annual premium contribution for consumers getting subsidies on the marketplaces was $888. The subsidies provided under the ACA paid for an average $5,727 toward the annual premium, and the expanded subsidies first passed in 2021 kicked in an additional $705 on average. That means that instead of paying $888, enrollees would pay an average $1,593 without those enhanced subsidies. It’s an increase of 79%.
KFF has since updated that analysis, finding that the average increase would be 114% in 2026.
“The increase in premium payments with expiration of the enhanced premium tax credits is even higher than previously estimated for two reasons: Trump administration changes to tax credit calculations, and [r]ising 2026 premiums,” KFF said in its Sept. 30 report. It noted that insurers have proposed increasing premiums by a median 18% on the marketplaces. In their rate filings, insurers have cited rising health care costs and the impact of government policies, such as the expiration of the enhanced subsidies, which is expected to cause some healthier enrollees to drop their coverage, according to the Peterson-KFF Health System Tracker.
As we’ve explained before, the enhanced ACA subsidies were part of the American Rescue Plan, which President Joe Biden signed into law in 2021, during the COVID-19 pandemic. They were set to last for two years but were extended through the end of this year by other legislation.
Under the ACA, subsidies are available for people buying their own insurance on the ACA marketplaces if they earn between 100% and 400% of the federal poverty level (the starting point is 138% in states that adopted the Medicaid expansion). The enhancement launched in 2021 provided more generous subsidies and allowed those earning above the 400% poverty level cap to also get subsidies. However, those earners would have to contribute up to 8.5% of their income toward their premiums, as KFF has explained. With the enhancement, those earning up to 150% of the poverty level could get insurance for $0 out of pocket.
During the time of the enhanced subsidies, enrollment in ACA marketplace plans has more than doubled. Enrollment went from 11.4 million in 2020 to 24.3 million in 2025.
The Centers for Medicare & Medicaid Services reported that 12.8 million more people were receiving subsidies this year, compared with 2020. The vast majority of enrollees in 2025 — 92% — received subsidies.
If the enhanced subsidies expire as scheduled, the increase in out-of-pocket costs for those millions of Americans would vary depending on people’s circumstances and the state in which they live. KFF has a calculator that estimates various scenarios.
The Congressional Budget Office has estimated that 4.2 million more people will lack health insurance in 2034 if the enhanced subsidies are allowed to expire. (Sanders’ 15 million figure includes the CBO’s estimate that the number of uninsured will increase by 10 million due to the One Big Beautiful Bill Act.)
While Democrats want to address the expiring subsidies in a government funding bill now, Senate Majority Leader John Thune said that Congress can have a conversation about that later on. “That doesn’t happen until the end of the year,” he said on NBC’s “Meet the Press” on Sept. 28 about the expiration of the enhanced subsidies. “We are going to have to have reforms if we take action there, but I think there is potentially a path forward.”
Thune noted that “these were plus-ups that were done in response to COVID. These were enhancements,” he said, adding that the entire premium tax credit program isn’t ending.
‘Lawfully Present’ Immigrants
In their continuing resolution to keep the government funded and open, the Democrats also proposed reversing some health care cuts for “lawfully present” immigrants, but the legislation doesn’t include coverage for immigrants who are not authorized to be in the U.S. Those immigrants are prevented by law from receiving federally funded health care. Yet Republicans have misleadingly said the Democrats want to “fund healthcare for illegal aliens.”
Senate Republicans claimed on their official X account on Sept. 22, “DEMOCRAT DEMANDS: ‘Give illegal aliens free healthcare.’” A few days later, Vice President JD Vance said on X, “Democrats are about to shutdown the government because they demand we fund healthcare for illegal aliens.”
House Minority Leader Hakeem Jeffries called the Republican claim “an outright lie.” In an interview on CNBC on Sept. 30, Jeffries said, “Federal law prohibits the use of taxpayer dollars to provide medical coverage to undocumented individuals. That’s the law. And there is nothing in anything that we have proposed that is trying to change that law.”
A spokesperson for Senate Minority Leader Chuck Schumer emailed a statement to us saying, “Undocumented immigrants cannot receive premium tax credits by law. The federal government does not fund health insurance coverage for undocumented immigrants in Medicaid or Medicare by law. Republicans have predictably resorted to lying about Democratic priorities because they know how unpopular their position is.”
In an interview on CNN’s “State of the Union” on Sept. 28, Republican House Speaker Mike Johnson said, “Yes, it is illegal for illegal aliens to receive health care paid for by hardworking American taxpayers. But [Democrats are] making the demand to change that. … That’s one of Chuck Schumer’s primary demands to keep the government open.”
As we said, in their proposed continuing resolution to keep the government funded, Democrats have sought to extend the ACA enhanced subsidies and roll back Medicaid cuts that were part of the GOP’s One Big Beautiful Bill Act. Those policies largely affect low-income Americans. But the Democrats also want to reverse parts of the law affecting health care coverage for those referred to as “lawfully present” immigrants.
The term “lawfully present” refers to noncitizens who have “qualified” immigration status that makes them eligible for Medicaid or the Children’s Health Insurance Program, KFF explains. Groups who would qualify include lawful permanent residents, refugees, parolees, individuals granted asylum, and certain victims of domestic abuse or human trafficking, among others.
Julia Gelatt, associate director of U.S. immigration policy at the nonpartisan Migration Policy Institute, told us the term “lawfully present” is “not a category fully defined in immigration law.”
“Some people who are in the ‘lawfully present’ categories would be considered by most people as legal immigrants — such as refugees and asylees and victims of trafficking.” But it is “a politically contested categorization,” Gelatt said.
In a Sept. 2 press release, Republican Reps. Brett Guthrie of Kentucky, Jason Smith of Missouri and Jodey Arrington of Texas said the groups affected by the One Big Beautiful Bill included “1.2 million illegal immigrants or non-citizens made eligible for taxpayer-funded subsidies via Democrat-created loopholes, who will no longer receive Obamacare subsidies after years of Biden-Harris abuse of ‘lawful presence’ definitions.”
The Republicans’ tax cut and budget bill signed into law in July changed coverage for noncitizens by capping the amount of emergency Medicaid funds that providers, such as hospitals, receive in reimbursement for care given to immigrants. It also changed the criteria for Medicaid enrollment to exclude those granted asylum and parolees, according to a fact sheet produced by the vice president’s office and sent to us.
In a clip from a Fox News interview Vance posted on Oct. 1 on X, he said, “There are two Biden-era programs that explicitly gave the taxpayer health care money to illegal aliens that we turned off when President Trump took over in January. Program number one is, there’s a lot of emergency health care at hospitals that are provided to illegal aliens. That was funded by the federal government. We turned off that funding because, of course, we want American citizens to benefit from those hospital services, not to be taxed and to have those hospital services go to illegal aliens. The second of which is, the Biden administration gave mass parole to millions upon millions of illegal aliens and then they simultaneously made those parolees eligible for health care benefits funded by taxpayers. In the One Big Beautiful Bill, President Trump and congressional Republicans turned off that money to health care funding for illegal aliens. The Democrats want to turn it back on.”
Parole is a legal permission granted to noncitizens to temporarily live in the U.S. for “urgent humanitarian or significant public benefit reasons.” Biden extended parole to immigrants from countries such as Cuba, Haiti, Nicaragua and Venezuela (all of which has been reversed by Trump). According to congressional testimony from Steven A. Camarota, director of research at the Center for Immigration Studies, an organization that favors low immigration, about 2.8 million people were granted parole during the Biden administration.
So, Republicans are saying that parolees are in the country illegally, even though they were considered “lawfully present.”
KFF reported that the Congressional Budget Office estimated that the coverage restrictions in the Republicans’ tax and budget law “will result in 1.4 million lawfully present immigrants becoming uninsured with $131 billion in reduced federal spending and $4.8 billion in increased federal revenues by 2034.”
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