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

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WASHINGTON (AP) — Democrats believe health care is an issue that resonates with a majority of Americans as they demand an extension of subsidies for their votes to reopen the shuttered U.S. government. But it is also one of the most intractable issues in Congress — and a real compromise is unlikely to be easy, or quick.

There are some Republicans in Congress who want to extend the higher subsidies, which were first put in place in 2021 amid the COVID-19 pandemic, as millions of people who receive their insurance through the Affordable Care Act marketplaces are set to receive notices that their premiums will increase at the beginning of the year. But many GOP lawmakers are strongly opposed to any extension — and see the debate as a new opportunity to cut back on the program altogether.

“If Republicans govern by poll and fail to grab this moment, they will own it,” wrote Texas Rep. Chip Roy, a Republican, in a letter published in the The Wall Street Journal over the weekend. He encouraged senators not to go “wobbly” on the issue.

“The jig is up, the pandemic is over and my colleagues shouldn’t blink in any other direction,” Roy wrote.

Republicans have been railing against the Affordable Care Act, former President Barack Obama’s signature health care law, since it was enacted 15 years ago. But while they have been able to chip away at it, they have not been able to substantially alter it as a record 24 million people are now signed up for insurance coverage through the ACA, in large part because billions of dollars in subsidies have made the plans more affordable for many people.

Now, some of them see the Democrats’ fight as their chance to revisit the issue — putting Republican congressional leaders and President Donald Trump in a complicated position as the government shutdown enters its seventh day and hundreds of thousands of federal workers are going unpaid.

“I am happy to work with Democrats on their Failed Healthcare Policies, or anything else, but first they must allow our Government to reopen,” Trump wrote on social media Monday night, walking back earlier comments saying there were ongoing negotiations with Democrats.

Senate Majority Leader John Thune, R-S.D., has repeatedly indicated that Republicans are open to extending the subsidies, with reforms, if Democrats would reopen the government. But he has refused to negotiate until that happens — and has suggested Trump will be key to the eventual outcome.

Thune told reporters Monday “there may be a path forward” on ACA subsidies, but stressed, “I think a lot of it would come down to where the White House lands on that.”

Some GOP senators argue the only path forward is to overhaul the law. “The whole problem with all of this is Obamacare,” said Florida Sen. Rick Scott.

Most House Republicans agree. House Speaker Mike Johnson said that Democrats decided to “pick a fight on health care” but that Republicans believe the system is broken and needs to be overhauled. “That issue is for debate in the next three months,” Johnson said. ”We have members working on that."

Democrats believe that public sentiment is on their side and argue that Trump and Republicans will have to come to the negotiating table as people who are enrolled in the program, many of whom live in Republican districts and states, are notified that their rates will increase.

“All I can tell you is the American people feel very deeply about solving this health care crisis,” Schumer said after the Senate rejected a House-passed bill to reopen the government for the fifth time Monday evening.

With leaders at odds, some rank-and-file senators in both parties have been in private talks to try to find a way out of the shutdown. Republican Sen. Mike Rounds of South Dakota has suggested extending the subsidies for a year and then phasing them out. Senate Appropriations Committee Chairwoman Susan Collins, R-Maine, has suggested pushing ahead with a group of bipartisan spending bills that are pending and a then securing a commitment to discuss the health care issue.

But many Democrats say a commitment isn’t good enough, and Republicans say they need deeper reforms — leaving the talks, and the U.S. government, at a standstill.

Maine Sen. Angus King, an Independent who caucuses with Democrats, voted with Republicans to keep the government open. But he said Monday that he might switch his vote to “no” if Republicans do not “offer some real solid evidence that they are going to help us with this crisis” on health care.

Republican Sen. Markwayne Mullin of Oklahoma said his party is “not budging,” however.

“First and foremost, before we can talk about anything, they need to reopen the government," Mullin said.

Still, some Republicans say they are open to extending the subsidies — even if they don’t like them — as it becomes clear that their constituents will face rising costs.

“I’m willing to consider various reforms, but I think we have to do something,” said Republican Sen. Josh Hawley of Missouri. He said Congress should address the issue “sooner rather than later” before open enrollment begins Nov. 1.

Rep. Marjorie Taylor Greene, R-Ga., said she is “not a fan” of Obamacare but indicated she might vote to extend it.

“I’m going to go against everyone on this issue because when the tax credits expire this year my own adult children’s insurance premiums for 2026 are going to DOUBLE, along with all the wonderful families and hard-working people in my district,” she posted on social media Monday evening.

With both sides digging in, the shutdown could go on for some time, leaving federal workers without their regular paychecks. And the White House is now suggesting that they may block backpay if the government reopens.

Trump signed legislation into law in 2019 that ensures backpay for federal workers during any government funding lapse. But a White House memo with the rationale for no backpay is under consideration, according to a person familiar with the situation and granted anonymity because they were unauthorized to discuss it.

Johnson told reporters Tuesday that he doesn't know the details of the memo, but “if that is true, that should turn up the urgency and the necessity of the Democrats doing the right thing here.”

Democrats pushed back on the White House rationale. “Federal workers, including furloughed workers, are entitled to their backpay following a shutdown," said Washington Sen. Patty Murray, the top Democrat on the Senate Appropriations Committee.

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Associated Press writers Matt Brown, Stephen Groves and Joey Cappalletti contributed to this report.