This government shutdown is different from the ones that came before. It isn’t only about Washington gridlock — it’s about millions of Americans across the country who could lose affordable health coverage. By refusing to extend the Affordable Care Act’s enhanced premium tax credits (PTCs), Republicans are holding both the government and families’ health care hostage — and misleading the public about the Democrats’ alternative.
Introduced in 2021, the enhanced tax credits have been a lifeline for low- and middle-class families with Affordable Care Act coverage. Thanks to these credits, households with incomes under 150% of the federal poverty level — just $48,225 for a family of four — can enroll in health care coverage with a $0 premium. Roughly 90% of people who receive marketplace coverage have their premiums reduced by enhanced PTCs. That includes many middle-class families, who use the credits to cap premium costs at 8.5% of household income.
Congressional Republicans have had multiple chances to prevent this.
If the enhanced tax credits expire at the end of this year, the aid for low-income families is greatly reduced; for middle-income families, it disappears entirely. Average premium costs would more than double for the 20 million Americans who rely on them, and in some states they could spike by over 300%.
Congressional Republicans have had multiple chances to prevent this. They refused to extend the enhanced PTCs during the negotiations and passage of President Donald Trump’s “big beautiful bill.” Now, with the clock ticking, they’re playing politics with families’ health. The timing could not be more urgent. Open enrollment for 2026 begins Nov. 1, but families trying to budget for the year ahead will be left to guess whether their premiums will stay manageable or suddenly double. Faced with financial shock, many will drop coverage, gambling that they can get by without health insurance.
The result will be millions more uninsured Americans — on top of the 10 million people already set to lose health insurance from the megabill’s cuts to Medicaid and other health care programs. Hospitals and other providers will face billions in unpaid care costs.
Rather than confront the looming premium hikes, Republicans have fallen back on a familiar — and risible — tactic. From the White House to Capitol Hill, GOP leaders have falsely claimed that Democrats have shut down the government to provide health coverage to undocumented immigrants. Last week, for example, the White House released a memo claiming that congressional Democrats’ proposal to reopen the government “would result in nearly $200 billion spent on healthcare for illegal immigrants and other non-citizens over the next decade.”
This is simply not true.
Meanwhile, the “clean” continuing resolution Republicans are floating is anything but clean.
Here are the facts: ACA coverage is available only to U.S. citizens and lawfully present immigrants. Everyone who applies for marketplace coverage must have their citizenship or immigration status verified against federal records before receiving assistance. Democrats are not trying to rewrite this prohibition to end the shutdown. Democrats seek simply to protect affordable coverage for millions of American families.
What Republicans don’t want to admit is that the “big beautiful bill” strips ACA eligibility from some lawfully present immigrants. Those losing eligibility include survivors of domestic violence and human trafficking with approved visas, refugees fleeing war in Ukraine or Afghanistan admitted through lawful pathways, and workers on visas whose green card petitions have already been approved. The nonpartisan Congressional Budget Office projects that 1.4 million lawfully present immigrants will lose coverage as a direct result of Republicans’ changes. House Democrats’ continuing resolution sought to restore coverage eligibility for these groups. By spreading misinformation, Republicans are trying to draw attention away from their refusal to protect millions of Americans’ access to affordable coverage. Meanwhile, the “clean” continuing resolution Republicans are floating is anything but clean. It would allow the Trump administration to continue illegally slashing funding for critical health priorities, including the National Institutes of Health. That’s not a solution. To keep the government open and health care within reach for working and middle-class households, Republicans need to stop the political games and negotiate with Democrats. Failure to do so will mean higher premiums for millions of families, more people priced out of coverage, and rising uncompensated care. Health care is at the heart of this shutdown fight, and families deserve real relief, not excuses or falsehoods.
Natasha Murphy
Natasha Murphy is the director of health policy at the Center for American Progress. 
