Democrats are betting their hopes on healthcare as a political battleground, especially as a government shutdown looms and midterms approach. With a year to go until the election, Democratic lawmakers are eager to ignite a debate on healthcare policy. Their strategy hinges on a clever move: linking an extension of ObamaCare’s enhanced tax credits to government funding bills. If Republicans refuse to negotiate and the government shuts down, Democrats argue they’ll blame the GOP for the fallout, while still claiming victory in healthcare reform. This tactic mirrors their past successes, where they’ve used healthcare as a rallying point to challenge Republicans in Washington.
“They can have their cake and eat it too,” said a familiar source, emphasizing the dual goal of appeasing their base and securing a meaningful policy win for their constituents. The plan involves working to secure tax credits that would help people afford coverage, but also ensuring healthcare remains a top priority in public discourse. The goal is to sway swing voters in the upcoming elections while keeping healthcare at the center of political conversations.
The Trump administration has amplified healthcare’s spotlight through controversial policies, like public health directives on vaccines and painkillers for pregnant women. As Democrats push back against the administration and congressional Republicans, healthcare becomes a high-stakes issue for a dramatic showdown. A longtime Democratic strategist, Brad Woodhouse, called it “a program that needs reform, but I think everybody is willing to sit down and talk about how to make that happen in a context where it should be discussed, not as a hostage to keep the government open.”
Without action, the enhanced tax credits—launched during the pandemic to help families afford insurance—will expire at the end of the year. If they do, average premiums for ACA enrollees could rise by over 75%, according to KFF. Congress has extended these subsidies twice, but now Republicans control the entire government, and many conservatives are content to let them expire. Democrats insist the extension must be part of any short-term funding bill, while GOP leaders are open to the idea of a temporary extension, possibly with policy changes, but only after November or December.
Senate Majority Leader John Thune (R-S.D.) warned that delaying the extension risks worsening the situation: “This is a program that needs reform, but I think everybody is willing to sit down and talk about how to make that happen in a context where it should be discussed, not as a hostage to keep the government open.” However, insurers are already setting rates, and open enrollment for ACA plans begins Nov. 1. Some people are already receiving notices of significant rate hikes. If Congress waits until the end of the year, most Healthcare.gov users will have already selected plans.
The Congressional Budget Office notes that extending the deadline beyond September 30 would save the federal government money, but consumers would still face higher premiums. If Republicans don’t compromise, a shutdown could strengthen Democrats’ position and bring even more attention to the healthcare debate they want to pursue. Even if Democrats manage to reach an agreement, other healthcare issues—like Medicaid cuts and rural hospital closures—make Republicans vulnerable.
“Short of Republicans doing a 180 and reversing Medicaid cuts, or forcing RFK Jr. to resign, healthcare should be a big issue next year, and they’ll pay the price,” said Woodhouse. While no Republicans have called for Robert F. Kennedy Jr. to resign, some have expressed concerns about his vaccine policies. President Trump’s recent pushback against Tylenol use during pregnancy has sparked outrage.
Senator Chuck Schumer (D-N.Y.) highlighted broader Democratic attacks, including a $1 trillion Medicaid cut that funded Trump’s tax cuts. “It’s not just the ACA tax credits… the cuts to Medicaid in the big, ugly bill. They’re closing rural hospitals and clinics. They’re closing long-term care facilities. People are losing jobs. State and local economies are suffering, and entire communities are going to be left without care,” he said.
Polls show voters trust Democrats on healthcare more than any other issue. A Third Way memo urged Democrats to prioritize healthcare costs as a non-negotiable demand. “Democrats should refuse to participate in a bipartisan effort to fund the government unless the GOP solves the health care cost crisis they alone caused,” the memo stated.
Darbin Wofford, Third Way’s health care director, warned that if tax credits expire and Medicaid cuts take effect, patients and providers will feel the pain through next November. The stakes are high, and the debate is far from over.
