Shutdown Fight Reopens Debate in G.O.P. Over Health Care

The federal shutdown that is nearing its fourth week with no end in sight carries plenty of political risk for Democrats, who Republicans have accused of refusing to fulfill their responsibility to fund the government.

But it has also thrust President Trump and the G.O.P. onto the defensive on health care, an issue that has long been a major weakness for the party.

Democrats in Congress are holding fast to their position that they will not agree to a spending deal unless Republicans include an extension of expiring Affordable Care Act tax credits that would stave off premium increases and the loss of coverage for millions of Americans.

In doing so, they have forced the G.O.P. to wrestle publicly with its divisions about what to do with the health care law, which most Republicans revile but many recognize would be impossible to unravel without bringing political disaster to their party.

Some hard-line Republicans are still pressing to repeal Obamacare outright, while others concede it is unwise to do so without a clear plan of what to do instead — something that their party has long discussed but has never been able to agree upon. Mr. Trump, who told Republicans in 2023 to “never give up” in seeking to repeal the 2010 health law, has yet to clearly articulate what he favors instead.

For now, Republican leaders in Congress have mostly opted to try to change the conversation, insisting that they have a health care plan but declining to describe what it is.

“This is not a health care fight,” Speaker Mike Johnson insisted in a television interview last week when discussing the shutdown impasse. Democrats, he added, “have created a red herring. The subsidies don’t expire until the end of the year. They grabbed that issue from the end of the year and pulled it back into September.”

Whether or not Mr. Johnson wants to have a health care debate, the prolonged shutdown has forced him and his colleagues to defend their opposition to tax credits that are popular across the political spectrum.

Representative Steve Scalise of Louisiana, the No. 2 Republican, for instance, told Punchbowl News on Friday that he would vote against extending the tax credits because they would be used to “bail out insurance companies.”

But the majority of people who receive the subsidies live in Republican congressional districts. Fourteen House Republicans, including many of the party’s most vulnerable members who represent swing districts, have signed on to legislation re-upping the tax credits until January 2027. Several G.O.P. senators have signaled a desire to extend them.

At the same time, some members of the hard-right House Freedom Caucus are once again calling to repeal Obamacare outright, a stance that thrills Democrats and that many G.O.P. strategists concede is politically disastrous.

“Health care will keep getting more expensive until we repeal Obamacare,” Senator Mike Lee, Republican of Utah, wrote in a recent post on X. “So Congress should repeal Obamacare.”

“Republicans ran on this for a decade,” he added. “We shouldn’t run from it now.”

Yet as early as last summer, Mr. Trump’s longtime pollster, John McLaughlin, flashed a red warning light to Republicans in Washington on health care, telling them privately and publicly that if Congress failed to extend the Obamacare subsidies, it could be a “potential political catastrophe for the G.O.P.”

On Thursday, Senator Chuck Schumer, Democrat of New York and the minority leader, said on a Zoom call hosted by Protect Our Care, a liberal health care advocacy organization, that if Republicans failed to change their position, they would be responsible for skyrocketing health care costs that would force some people to forego coverage altogether.

“Three times, we’ve asked the Republicans to vote simply to extend the tax credits, and three times, they voted it down,” Mr. Schumer said. “Now, 20 million will see their health care costs more than double. If you’re older, it hits you even harder.”

Until recently, Mr. Schumer added, Mr. Johnson was telling his members, “Don’t even discuss health care. Now he says ‘Oh,’ he wants to talk about health care. But he really doesn’t. Not about the health care you need.”

In 2017, the last time Republicans controlled a governing trifecta in Washington, at the dawn of Mr. Trump’s first term, they became painfully aware that turning their intense hostility toward the Affordable Care Act into a legislative alternative was incredibly difficult. They failed, in what Republicans now regard as a cautionary tale.

“I still have PTSD from the experience,” Mr. Johnson said recently.

Democrats gained 40 House seats in the following year’s midterm elections, and they credited health care as the reason. They had aired commercials accusing Republicans of placing an age tax on people over 50 and of raising the cost of health coverage for people with preexisting conditions.

“Health care was on the ballot, and health care won,” former Speaker Nancy Pelosi said at the time.

In the years since, G.O.P. lawmakers have continued to say they want to “repeal and replace” Obamacare, but have come no closer to defining what “replace” would look like.

“I have concepts of a plan,” Mr. Trump famously said during a presidential debate last year, eliciting a sly smile from his opponent, Vice President Kamala Harris. As president, however, Mr. Trump has outlined no such plan. For years, he has vacillated between saying that Obamacare is “lousy health care” that needs to be abolished, and saying he is open to keeping it but overhauling pieces.

Mr. Johnson conceded this week that repealing the 2010 law was not possible because its “roots are so deep.”

The absence of a strong message from Mr. Trump on health care as the shutdown has dragged on has also contributed to a scattered strategy from Republicans when talking about the issue.

In an Oval Office meeting with Mr. Trump and Democratic congressional leaders the day before the shutdown deadline, Mr. Johnson said that health care was an “extraneous” issue, according to Representative Hakeem Jeffries, Democrat of New York and the minority leader.

Republicans then tried accusing Democrats, misleadingly, of shutting down the government in order to give free health care to undocumented immigrants. These days, that talking point appears to have fallen by the wayside. Instead, they are describing themselves as the party of health care.

“Republicans are the party that are fixing health care,” Mr. Johnson insisted earlier this month. He has noted that Mr. Trump’s marquee tax cut and domestic policy law is projected to lower health care premiums. But he has not mentioned that it does so by 0.6 percent by 2034, according to the Congressional Budget Office, which also estimated that the law would cause millions of Americans to lose Medicaid coverage because of cuts to the program.

Mr. Jeffries offered a quick response online, pointing out in a video that “for the last 15 years, Republicans have tried more than 70 different times to repeal the Affordable Care Act. There is zero reason — zero — to trust Republicans on health care.”

For now, Democrats believe that a prolonged discussion of health care is so advantageous to them that it is worth the political risk of a lengthy shutdown.

A recent poll conducted for the Senate Majority PAC, which supports Democrats, found that by a 2-to-1 margin, voters said that their “health care priorities” were more important to them than concerns about a long shutdown.

Some Democrats are hoping that they will see a replay of the 2018 midterm election cycle next year.

Republicans are “turning themselves into a gigantic obstacle to solving a health care crisis,” Geoff Garin, the Democratic pollster who conducted the survey, said in an interview. “There’s no question that this is going to come back and haunt them in next year’s elections."

Mr. Garin said that was not because Republicans were foolish. What the impasse showed, he said, was how the G.O.P.’s core beliefs on health care were fundamentally at odds with those of a large majority of Americans.

Most Republicans oppose the government subsidies for health care because they argue that they are driving up insurance costs, while Democrats argue the government should help Americans afford health care no matter the cost.

At least one Republican, Representative Marjorie Taylor Greene of Georgia, appears to be aware of the disconnect between voters and G.O.P. lawmakers in Washington.

In a podcast interview last week, Ms. Greene said she was frustrated that she could not find “the Republican plan to fix the absolutely destroyed health insurance industry.”

In a social media post, she wrote: “I’m absolutely disgusted that health insurance premiums will DOUBLE if the tax credits expire this year. Not a single Republican in leadership talked to us about this or has given us a plan to help Americans deal with their health insurance premiums DOUBLING.”

Even Joe Kernen, the conservative co-host of CNBC’s Squawk Box who has been publicly supportive of Mr. Johnson’s stance in the shutdown fight, told the speaker: “Republicans are in the wilderness on what to try to do to fix our health care.”

“Actually, we’re not,” Mr. Johnson replied. “We’ve got pages and pages and pages of ideas on how to reform health care. You can’t rip Obamacare out at the roots; it’s too deeply ingrained. We have to increase access to care, quality of care, and bring down the costs.”

He did not elaborate on his party’s ideas to do so.