Senate Republicans face states’ healthcare concerns in high-stakes shutdown standoff

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By Bo Erickson, Richard Cowan and Nolan D. McCaskill

WASHINGTON (Reuters) -A handful of U.S. Senate Republicans are wrestling with the impending expiration of health insurance subsidies that are the primary sticking point in the government shutdown standoff that entered its 13th day on Monday.

The lawmakers have not voted in favor of a proposal put forward by Senate Democrats to extend the subsidies. However, the senators are talking with the White House and Democrats about a possible way to address the surge in health insurance costs. Some Republicans said failure to resolve the issue could become a liability in the 2026 midterm elections, which will determine control of Congress. 

Small business owners, gig workers and farmers who do not get health insurance through their employers are beginning to receive notices of sharp increases in premiums for policies bought through the Affordable Care Act, also known as Obamacare.

Many live in Republican strongholds, and those primarily at risk are middle-class Americans making $60,000 to about $105,000 annually, according to insurance experts, because they most benefited from enhanced subsidies started by Democrats during the COVID pandemic.

The enhanced subsidies expire at the end of the year.

“We’ve got to make sure that premiums don’t go sky-high,” Senator Tommy Tuberville, a Republican running for governor of Alabama, told Reuters.

Tuberville, along with five other Senate Republicans including Lisa Murkowski, Josh Hawley, Susan Collins, Thom Tillis and Jim Justice, have publicly shared concerns about the impending expiration.

Senate Democrats launched this Washington battle by using their leverage on a funding bill that is needed to keep government programs running. At least 60 votes are required to clear the way for passage of a stopgap bill and Republicans control the Senate by a narrow 53-47 margin.

Without a healthcare deal, Senate Minority Leader Chuck Schumer argued, “People will go bankrupt, people will get sick, people will die.”

Democratic senators have so far voted seven times against the Republicans’ short-term funding plan. Three Democrats have broken from the party and voted with Republicans, arguing short-term shutdown impacts on Americans are too painful to hold out for ACA negotiations.

OBAMACARE ENROLLMENT SURGED IN REPUBLICAN STATES

While Republicans in Congress fought hard against Obamacare, the number of people enrolling in their states and districts has surged over the past five years as the expanded subsidies were available, according to an analysis by the healthcare nonprofit KFF. 

Twelve of the 15 states where Obamacare enrollment has grown the fastest are represented by Republican senators, with enrollment having more than tripled in Texas, Mississippi and Louisiana over that time.

Overall, 77% of Obamacare enrollees nationwide are in states President Donald Trump won in 2024, according to the analysis.

Murkowski, an Alaska Republican, told reporters that senators have “spitballed” solutions with colleagues across the aisle. 

Asked by reporters if she gets “any love” for the idea of a two-year ACA tax credit extension she has proposed for ending the shutdown, Murkowski poked fun at her fellow Republicans.

Lapsing into a theatrical, low voice imitating a male senator, she said, “We have to open the government first before I can talk to you.”

Last week, Trump said a “deal” on healthcare “could lead to very good things,” only to backtrack on the possibility of negotiations.

Republican Representative Marjorie Taylor Greene of Georgia, where enrollment has also tripled, recently broke with her party and blamed leadership for not prioritizing the healthcare concerns.

As the 2026 midterm elections near, a group of House Republicans in competitive districts nationwide are trying to fill the gap and push for a one-year subsidy extension.

“If these subsidies expire and there is no other fix, many current enrollees would cancel their plans,” said Cameron Ellis, a University of Iowa finance professor and health insurance expert. “The healthier people would drop coverage and this would raise the premiums for everyone in the ACA marketplace beyond the removal of the subsidy itself.”

ACA POLITICS AND DISTRUST ON CAPITOL HILL

This is the latest chapter in a 15-year tussle that has seen Republicans trying to repeal or maim Obamacare, claiming the government should get out of the health insurance business. 

The 2013 federal shutdown was instigated by hardline Republicans seeking to delay or defund Obamacare.

Subsequently, other Republicans have continued to highlight Obamacare’s shortcomings and this skepticism could sink a future deal. 

“We’ve got to fix Obamacare, which is causing prices to go up,” said Senator Rick Scott of Florida, arguing the quality of coverage is not worth the price.

On Sunday, Vice President JD Vance also questioned aspects of the subsidies and pushed for deregulation.

The 2013 shutdown ended with a compromise not to rework Obamacare, but on a promise to negotiate a bipartisan budget.

This time, Democrats say they have less trust in Republicans.

“We want to work with them now to get a vote on this,” Democratic Senator Patty Murray of Washington said as lawmakers left town last week without a solution. “We know darn good and well that if we just throw our hands up in the air and say, ‘We’ll trust you later!’ the chances of it happening are not there.”

(Reporting by Bo Erickson, Richard Cowan and Nolan McCaskill; editing by Scott Malone and Diane Craft)