The looming expiration of enhanced Affordable Care Act (ACA) premium subsidies has become the centerpiece of the ongoing government shutdown crisis. Republicans are now pushing to reopen government operations first and negotiate a potential extension of these critical subsidies afterward, creating uncertainty for millions of Americans who rely on subsidized healthcare coverage.
The enhanced subsidies, which have kept healthcare costs manageable for exchange enrollees since their implementation, are set to expire at the end of the year. Without congressional action, millions of Americans could face dramatic premium increases starting in 2026.
Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services (CMS), issued a stark warning during his appearance at the Aspen Institute on Monday afternoon. He characterized the government shutdown as a “public health emergency,” highlighting the unprecedented challenges facing healthcare policymakers.
Key Personnel Unavailable During Shutdown
Dr. Oz emphasized that the shutdown has sidelined the agency’s most experienced staff members—precisely those needed to develop strategic solutions. “The people who aren’t there are the ones that we would crutch on to be able to figure out the best path forward,” he explained. “And even if you want to do it now, you don’t want to make a decision of this importance in the middle of a shutdown when folks aren’t at work and there’s a lot of vitriol going back and forth.”
House Speaker Mike Johnson, R-La., offered a more optimistic perspective on Monday, suggesting that reopening the government would provide ample time for bipartisan negotiations. According to Johnson, if a resolution passes to keep the government funded and restart operations quickly, both parties would have sufficient time to address the subsidy expiration before year-end.
Three Months to Negotiate
“We have effectively three months to negotiate,” Johnson stated in an interview with MSNBC. “In the White House and in the halls of Congress, that’s like an eternity.” However, this timeline may be more compressed than it appears, particularly given the approaching open enrollment period.
The timing of these political negotiations creates significant challenges for consumers. Open enrollment on HealthCare.gov begins November 1, when millions of individuals will discover firsthand how dramatically their premiums have increased due to the likely expiration of tax credits.
Dramatic Cost Increases Expected
An analysis from KFF reveals alarming projections for 2026 healthcare costs. Health plans requested a median increase of 18% for 2026—a full 11 percentage points higher than requests for the 2025 plan year. These increases will hit hardest for Americans who have relied on enhanced subsidies to make coverage affordable.
Democratic Concerns About Timing
Democrats have consistently argued for extending the subsidies before agreeing to reopen the government. They cite a Congressional Budget Office estimate indicating that delaying action would limit potential premium reductions in 2026, leaving consumers to shoulder higher costs throughout the year.
Despite the challenges, Dr. Oz indicated that CMS has several mechanisms available to cushion the impact of rising premiums. While health plan premium rates are currently locked in, the agency can adjust what enrollees ultimately pay through various administrative tools.
Tax Credits as a Primary Lever
Tax credits represent one of the most powerful tools available to CMS for managing consumer costs. “Obviously it would be nice to do that before the end of this calendar year, because you start having to pay those at the beginning of next year,” Dr. Oz noted, emphasizing the urgency of the timeline.
The debate over ACA subsidies isn’t occurring in a political vacuum. Recent polling demonstrates overwhelming public support for maintaining these critical benefits across party lines.
A recent survey from KFF found that extending the subsidies enjoys broad popularity, including among Republican voters. Overall, 78% of voters support an extension of the tax credits, suggesting that any political solution should reflect this bipartisan consensus.
Dr. Oz also addressed the Trump administration’s heightened focus on fraudulent sign-ups and broker misbehavior on the exchanges. These concerns have introduced additional complexity to the subsidy debate and enrollment processes.
Suspicious Enrollment Patterns
A startling statistic emerged from Dr. Oz’s remarks: half of enrollees in ACA plans filed no medical claims last year. This pattern contradicts typical consumer behavior, where people generally utilize insurance they’re paying for, raising questions about the legitimacy of many enrollments.
Awareness and Improper Enrollments
Many individuals may not realize they’re enrolled in exchange plans or understand their coverage level. Data from the Paragon Health Institute, a right-wing think tank, estimates that as many as 5 million people may have been improperly enrolled on the exchanges in 2024.
Criminal Elements and Enforcement
“I do think that there are criminal elements,” Dr. Oz stated. “There are Department of Justice cases that have been won against brokers who have gamed the system, especially if you’re looking at some of the ways policies were issued.”
The CMS implemented key changes to open enrollment this year designed to address these improper sign-ups, though these modifications may also contribute to rising premiums by reducing the overall pool of enrollees.
The concerns around improper enrollments fall under the Trump administration’s broader initiative against fraud, waste, and abuse across all government sectors. However, Dr. Oz acknowledged that anti-fraud measures, while necessary, could reduce overall enrollment numbers and subsequently drive up premiums for legitimate enrollees.
As the shutdown continues and the calendar moves toward open enrollment, millions of Americans remain in limbo, uncertain about their healthcare costs and coverage for 2026. The resolution of this crisis will require swift political action, administrative expertise, and a commitment to protecting affordable healthcare access for all Americans who depend on ACA subsidies.
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