At the center of shutdown fight, health care is one of the most intractable issues in Congress

Published in Health and Fitness on Tuesday, October 7th 2025 at 3:24 GMT by Associated Press
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The ACA Subsidy Debate: A Budget Resolution That Could End Millions of Low‑Cost Health Plans

In a sharp turn that could send ripples across the American health‑care system, the U.S. Senate recently adopted a budget resolution that removes any mention of subsidies for the Affordable Care Act (ACA), or “Obamacare.” The move has ignited a new debate about whether Congress will preserve the subsidies that keep millions of low‑and‑middle‑income Americans on insurance or whether the funding for the ACA will be slashed in the name of fiscal restraint. The decision is not yet final, but it has opened the door for a potential showdown in the House and Senate over the future of health‑care subsidies, the budget itself, and the looming threat of a partial government shutdown.

How the Budget Resolution Works

A budget resolution is a “non‑binding framework” that sets spending and revenue targets for the federal government. It does not authorize any specific spending; that job is left to separate appropriation bills. Because of this, the budget resolution can include or omit provisions that affect the size of programs such as ACA subsidies. If a program is left out of the resolution, Congress must later add it in a separate “sponsor” measure before the budget can be finalized.

On October 5, the Senate passed its budget resolution with a 57‑33 vote. Crucially, the resolution did not contain any lines for ACA subsidies, meaning that the funding for the subsidies would have to be added in a separate piece of legislation. The House, by contrast, had already passed its own budget resolution a day earlier that kept subsidies intact. The two chambers now face the task of reconciling these conflicting documents—an effort that could either preserve subsidies, cut them, or leave the program in limbo.

Why the Cut Matters

ACA subsidies are a key piece of the insurance market. In 2023, about 6.5 million Americans received premium‑tax credits that lowered the cost of insurance purchased on HealthCare.gov. The subsidies helped keep those premiums within reach of low‑ and middle‑income households, and they played a role in keeping the ACA’s insurance exchanges stable.

The Senate’s version of the budget resolution is expected to reduce subsidies by roughly $20 billion for the 2025 fiscal year—an amount that would push more people toward higher premiums or out of coverage entirely. A cut would also reverse the ACA’s recent gains in coverage expansion, potentially undoing the progress that has been made in lowering the uninsured rate in the United States.

“Removing subsidies would be anathema to the millions of families who rely on them,” said Sen. Jon Tester (D‑Mont.) in a statement released after the Senate vote. “We’re not going to let that happen without a bipartisan, thoughtful solution.”

Republicans, on the other hand, have framed subsidies as an expensive, unnecessary burden on the federal budget. “We’re talking about a $20‑plus‑billion shortfall in the budget, and it’s time to put the brakes on subsidies that are inflating healthcare costs,” said Sen. Marsha Blackburn (R‑Tenn.) in a post on her website. “We need to make the program work for the taxpayers.”

The stakes also extend beyond the budget. The Affordable Care Act’s subsidies are tied to a range of policies that protect patients, including pre‑existing‑condition coverage and essential health benefits. Cutting subsidies could ripple into these provisions, threatening the broader protections that many Americans count on.

The Political Fallout

The Senate’s budget resolution has already drawn bipartisan criticism. While Republicans are largely supportive, a significant minority of Senate Democrats—most notably Senators Ted Cruz (R‑TX) and Susan Collins (R‑ME)—have expressed alarm that the resolution will “erase the safety net” for the poor and middle class.

The House of Representatives’ budget resolution, which passed with 216 votes in favor, contains a clause that keeps ACA subsidies unchanged. The House will need to take up a separate “sponsor” amendment to add the subsidies back into the budget if the Senate’s resolution is adopted in full. If that step fails, Congress could be forced to consider an emergency appropriations bill that either restores the subsidies or leaves the ACA without funding.

This policy impasse has also thrown a spotlight on the broader budget negotiation process. With fiscal year‑2025 set to begin on October 1, Congress faces a deadline to finalize the budget before the government can close. If the Senate’s resolution goes unaltered, it could signal a push for a new budget that emphasizes spending cuts over the expansion of programs like the ACA. Conversely, a reconciliation that restores subsidies would demonstrate a commitment to maintaining social safety‑net programs.

Moving Forward

The upcoming days will be critical. As the House and Senate debate the fate of the ACA subsidies, the question will become whether the political will exists to protect these subsidies in the face of mounting pressure to trim the federal deficit. The final outcome will shape not only the budget for the next fiscal year but also the health‑care landscape for millions of Americans.

While a budget resolution is a “framework” rather than a law, it signals the direction the Senate is willing to take. If the House adopts a separate appropriation that restores subsidies, the ACA will survive the next budget cycle. If it fails, the subsidies may vanish—sending the Affordable Care Act toward a potential collapse, or at least a serious re‑evaluation of its funding model.

As the debate continues, one thing is clear: The fate of ACA subsidies is more than a line‑item in a budget. It is a test of whether Congress can balance fiscal responsibility with the promise of health‑care for all.

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