As the federal government shutdown lingers, a great deal of coverage is focused on horse-race political analysis of who will win, the Democrats or the Republicans, and not enough on the stakes for average Americans.
The crux of this standoff is health care. Specifically, whether to extend or terminate the enhanced tax credits now available to people who purchase their health insurance through the Affordable Care Act marketplace. For the 24 million Americans who do so, including 390,000 Massachusetts residents, the financial impact of the Republican proposal to terminate the credits is enormous. On average, their premiums will more than double, according to a recent study by the Kaiser Family Foundation.
For some, the pain will be especially severe. For example, the Kaiser study estimates that a Florida couple in their 60s who earn $85,000 would see their annual insurance premiums nearly quadruple, from $7,200 to $28,500.
Many Affordable Care Act enrollees are unaware of the risk they face. But they will learn soon, as they receive annual reenrollment notices in the coming weeks that include steep increases for 2026. The response from enrollees surveyed by Kaiser unsurprisingly demonstrates the severe impact such an unexpected and unnecessary hike in their household expenses would have. Seventy percent responded that they will not be able to afford the increase and 40% expected that it will cause them to become uninsured.
Beyond the obvious health concerns this raises for patients, the potential impacts on the American economy and on our fragile health care system are enormous. Nearly half of Affordable Care Act enrollees are owners or employees of small businesses with less than 25 employees, or are self-employed. It is often said that small businesses are the engine of our economy. If that is so, doubling the insurance premiums of this entrepreneurial group is the policy equivalent of putting sand in the gas tank.
For hospitals, health centers and other providers, loss of insurance coverage by so many patients could be the final factor creating a perfect storm. Over 60% of Massachusetts hospitals had negative operating margins last year. Medicaid cuts contained in the “Big Beautiful Bill” will exacerbate those losses, with the CEO of Central Massachusetts’ largest health system estimating that the bill would cause it to lose at least $100 million annually in Medicaid funding.
On top of all that, if 40% of Affordable Care Act enrollees become uninsured because they can’t afford their premiums, the combined impact could be unsustainable, resulting in outright closure of some hospitals and almost certainly leading to layoffs for most. (Remember, hospitals treat everyone who arrives in their emergency rooms, regardless of insurance status, and bear the financial losses incurred from treating the uninsured.)
Although horse-race political analysis alone is deficient for such a serious issue, it could offer some hope. Small-business owners are typically a reliable constituency for Republicans, so the potential impact on them and their employees could be an incentive to cause congressional Republicans to yield. Moreover, polling demonstrates opposition to termination of the tax credits across the political spectrum. Surveys indicate that 78% of voters want the tax credits extended, including a majority of Republicans (albeit by a lower percentage than Democrats and independents).
The local stakes of this horse race are very high. Health insurance access for thousands of Massachusetts residents, the financial viability of entrepreneurial small businesses, and the sustainability of hospitals and health providers all stand in the balance. But sometimes it pays to lay down a bet on the long shot. Here, I’m betting (and hoping) that consensus can be reached to extend the credits and avoid these dire and completely unnecessary repercussions.
Jim Leary is an attorney and former state legislator from Worcester.
This article originally appeared on Telegram & Gazette: Opinion/Guest column: Stakes high for health care in shutdown