Amid shutdown, poll finds overwhelming support for ACA subsidies

Modern Healthcare – Friday, October 3, 2025
By Michael McAuliff

Survey results released Friday show broad-based and strong support for maintaining enhanced subsidies for health insurance exchange plans, which Democrats have made the focal point of their standoff with Republicans over government funding.

According to a poll from the health policy research institution KFF, 78% of respondents favor keeping the subsidies in place.

A majority of Republicans and core supporters of President Donald Trump back extending the subsidies. The survey found that 59% of Republicans want to them extended, as do 57% of “Make America Great Again” Republicans.

Unless Trump and the Republican congressional majority agree to renew the policy before the end of this year, financial assistance will revert to the lower level originally conceived in the Affordable Care Act of 2010.

The survey ran Sept. 23-29, just before the federal government shut down Oct. 1 over a partisan dispute over spending and other matters.

This snapshot of public opinion helps explain the rhetoric each side has deployed in the lead-up to the shutdown and the days since.

The GOP needs at least a few Democratic votes to advance a spending bill, but the minority party has refused to support a short-term funding bill that would have kept the government in operation for the first seven weeks of fiscal 2026.

Instead, Democrats are using the shutdown face-off as an opportunity to draw attention to the GOP’s health policy agenda, which includes the $1.1 trillion in cuts to Medicaid and the exchanges that are a central component of the tax law Trump enacted in July.

Democrats demand a permanent extension of the enhanced exchange subsidies and a rollback of the Medicaid and exchange cuts as a condition for backing legislation to fund the government.

Democrats have repeatedly accused GOP leaders of refusing to negotiate with them to avoid dramatic spikes in health insurance costs.

According to a separate KFF analysis, net premiums after subsidies are set to spike an average of 114% to $1,904 next year. Twenty-two million people are projected to see higher premiums.

Trump and congressional Republicans have chosen to focus their arguments on spending and immigration, often making claims that stretch or disregard the facts.

House Speaker Mike Johnson (R-La.) argued that Democrats’ true agenda is providing health benefits to undocumented immigrants, an assertion Trump has also made.

“They have made a decision that they would rather give taxpayer-funded benefits to illegal aliens than to keep the doors open for the American people to keep vital services,” Johnson said at a news conference Thursday.

Federal law has long forbidden unlawfully present migrants from accessing federal benefits and includes significant limitations for legal immigrants. Trump’s tax law toughend those restrictions.

Republicans have also attempted to cast Democrats as enemies of rural America, saying their plans would take away the $50 billion Rural Health Transformation Program included in the tax law.

“They want to remove the rural hospital fund the Republicans fought so hard to put into the ‘One Big Beautiful Bill,’” Johnson said. “A lot of those rural hospitals are in red states.”

Republicans conceived of the fund as a way to mitigate the effects of the tax law’s healthcare cuts on hospitals in rural areas. Repealing the healthcare cuts, as Democrats propose, would also eliminate the rural hospital fund.

According to KFF estimates, rural providers will lose $137 billion over 10 years because of the tax law’s healthcare cuts.

Despite the top line survey findings showing support for extending the tax credits, the Republican position has some political advantages.

When respondents were told extending enhanced tax credits would require significant spending, 63% said they would be concerned.

Another challenge for Democrats is that most people don’t know the tax credits are running out: 61% of respondents said they had heard “a little” or “nothing at all” about it.

Awareness may increase soon because the open enrollment period begins Nov. 1 and Democrats are likely to continue pressing the point.

The health insurance industry and an alliance of healthcare providers is ramping up advertising and lobbying campaigns appealing for Congress to extend the subsidies.

A handful of Senate Republicans have expressed openness to a deal on the subsidies, including Thom Tillis (N.C.), Dr. Bill Cassidy (La.) and Mike Rounds (S.D.), but insist Democrats should wait until after the government is funded.

GOP leaders remain steadfast that Democrats must support the stopgap spending bill as written. Congress will be back in session on Monday.

Access this article at its original source.