The federal government shut down Oct. 1, and the impasse between congressional Democrats and Republicans suggests it could be a long one. Speaker Mike Johnson has already sent Congress home to do “district work.” That may be related to the fact that newly elected Democratic Congresswoman Adelita Grijalva adds another vote to the Democratic column but cannot vote until she is sworn in. Johnson says she will be sworn in only when Congress returns to session, which will not happen until Democrats vote to reopen government with a “clean” continuing resolution that changes nothing in the current budget. 

Here’s the problem: People will receive notices about the cost of their health care sometime between October and early December, during the open enrollment period. They will have to make choices about their health plans and affordability — estimates suggest costs could rise between 10% and 15% and possibly more in some areas. How can people make rational decisions if they do not know how much they can pay? Premium tax credits embedded in the Affordable Care Act help millions afford coverage through the Marketplace. But these credits are set to expire at the end of 2025. Democrats want to extend them, and Republicans say they will “discuss” the issue once the government reopens. Republicans have a record of broken promises. Senate Minority Leader Chuck Schumer, D-N.Y., supported a Republican move in the spring, and it cost him both progressive support and leverage in managing the health care impasse. 

If Congress fails to act before open enrollment begins Nov. 1, many Americans could suddenly face steeper, possibly unaffordable premiums or choose to drop coverage entirely, worsening health access and market stability. And if premiums rise, some people will not be able to pay them. There are real consequences to denying health care. According to a Harvard University study, more than 45,000 people died in 2009 because they lacked coverage. While that study is dated, it provides a baseline. 

Most low-income households will be hit hardest by premium increases. Because African Americans are more likely than others to be at the bottom of the income distribution, they are most likely to be affected. Given current economic instability, many families could face serious hardship. This urgency is one reason Democrats have united around extending health care subsidies. Republicans appear intent on wasting time and avoiding Democrats at the negotiating table. They are following the lead of President Donald Trump, holding government operations hostage. 

The consequences of this showdown are immediate. Hospitals, particularly in rural and underserved areas already under financial strain, warn of funding shortfalls. Some Medicaid programs and payments to providers are in limbo. Even if core functions like Medicare and Medicaid continue — they are mandatory spending and technically shielded — agencies that administer ACA marketplaces or support outreach could face disruptions. Meanwhile, uncertainty may rattle insurers and consumers, potentially causing premium surges, fewer plan options or coverage losses, especially in areas where costs were already high. 

Republicans own this shutdown. They control both houses of Congress and the executive branch. Yet they are attempting to shift the narrative by claiming Democrats want to “give health care to undocumented immigrants.” Nothing could be further from the truth. Undocumented immigrants are not eligible for ACA subsidies or most federal health coverage, except for emergency care. Meanwhile, emergency rooms are closing. Where does this leave citizens, legal immigrants and undocumented people who need emergency care? 

Is affordable health care a right and moral obligation or an afterthought? Should health care be a political football or a foundation of a humane society? Partisanship around these issues ignores those who need coverage but are not in the same party as the oligarchs. Affordable health care should be nonnegotiable. 

Democrats have drawn a line in the sand, and Republicans have, too. They are playing “chicken” with tens of thousands of lives. This is more than an ordinary shutdown; it is a matter of life and death. 

The writer is an economist and author based in Washington.