Democrats take stand on healthcare as government shutdown looms

Democrats are threatening to shut down the government unless Republicans restore health insurance subsidies that would otherwise cause Iowa ACA enrollees to pay an extra $1,080 per year for coverage.

With just days left before the federal government could shut down, Democrats are insisting they won’t vote for any spending bill that doesn’t protect health care for millions of Americans set to lose coverage at the end of the year. 

And seemingly, President Donald Trump is urging Republicans in Congress to stay the course and refuse to negotiate.

The standoff centers around enhanced health insurance subsidies for the Affordable Care Act (ACA). The subsidies were boosted during the COVID-19 pandemic and are set to expire at the end of this year. Without them, millions of ACA enrollees, including an estimated 30,000 Iowans, will lose coverage, while millions more will pay more for the health insurance they already have.

Based on an analysis from health care think tank KFF, Iowans who buy health insurance through the ACA marketplace would see some of the largest increases in the country. On average, health insurance premium payments would increase by $1,080 annually, from $1,116 to $2,196 per year — a 97% increase. Other estimates project the average cost for ACA plans could more than triple for Iowans. 

Republicans are plodding along, hoping to pass a Continuing Funding resolution to keep the government open and the country on pace to end those insurance subsidies. Democrats see the threat of a shutdown as a rare point of leverage to avoid the premium hikes and loss of coverage.

Also on the line, Democrats are hoping to roll back some of the healthcare cuts included in Trump’s tax cut bill. The changes are estimated to increase the uninsured population in Iowa by roughly 80,000 people: 68,000 due to cuts to  Medicaid, 8,300 due to changes in the ACA, and another 3,400 due to changes to Medicare and policy interactions. Rural hospitals in the state are already bracing for large cuts that could force some providers to close.

Back in 2018, Trump threatened to shut down the government over border wall funding, presiding over the longest partial government shutdown in history. After getting most of what he wanted from Congress this year, including ICE funding and tax cuts for the rich, Trump is now playing defense.

The impacts of a shutdown wouldn’t be felt immediately for most Iowans. Medicare and Medicaid would continue to run. Social Security checks will still go out. The mail will still get delivered. But about 22,000 Iowans work for the federal government, and they’d all stop getting paychecks — even the ones who have to keep working. Airport security agents, air traffic controllers, and federal law enforcement officers would all be expected to show up without pay. These federal employees would receive backpay after the shutdown concludes.

For Iowa farmers, the timing couldn’t be worse. This is harvest season, and federal farm programs that provide loans and other support could be put on hold. The Agriculture Department might have to delay releasing crop reports that farmers and markets rely on to make decisions.

The government shuts down on Oct. 1 if Congress doesn’t act.