As the federal government shutdown enters its third week, some Americans are worried about the future of Affordable Care Act (ACA) subsidies.
For people who purchase coverage through the health insurance marketplace, subsidies or premium tax credits can help reduce or eliminate out-of-pocket costs for monthly premiums.
They were enhanced during the COVID-19 pandemic and are currently expected to expire at the end of 2025.
Democrats have been asking Republicans to pass an extension of the subsidy before the government reopens, while Republicans have said there will be no negotiations until the clean funding bill is passed and the government reopens.
A recent KFF analysis found that premium payments could more than double in 2026 if the ACA's enhanced premium tax credit expires.
Some Americans who rely on tax credits to help pay for some or all of their premiums told ABC News they worry that if the subsidies expire, they may be forced to choose less comprehensive insurance plans, or they may be unable to pay their premiums.
House Speaker Mike Johnson speaks at a press conference on Capitol Hill on October 20, 2025, weeks after the government shutdown continued.
Kelly Cooper/Reuters
We “can’t live without insurance”
Doug Butchart, 67, of Eglin, Illinois, told ABC News that his wife, Shadene, has amyotrophic lateral sclerosis (ALS) and currently receives coverage through the health insurance marketplace.
Shadene Butchart, 58, initially chose a Blue Cross Bronze plan, the lowest level, but as her disease progressed, the couple decided to upgrade to a Gold plan, the highest level, which covered a higher percentage of her health care costs.
The plan's premium is $1,273.82 per month. The Butcharts received an enhanced premium tax credit that covered $670 of their monthly premiums, leaving them paying $603.82 per month.
Doug Butchart said without the premium tax credit, they wouldn't be able to pay the entire premium out of pocket each month.
“I heard [premiums could rise] Between 25 and 50 percent,” he said. “It's unsustainable because we can't afford it but not be without insurance. “
Doug Butchart said his wife does not qualify for Medicare and they do not meet the income threshold to qualify for Medicaid.
“We're in a dilemma because typically, once you're diagnosed with ALS, you're automatically eligible for [Social Security Disability Insurance] and Medicare, but she doesn't have any work credits, so she doesn't qualify for Social Security disability,” he explained. “So now, we're on Social Security for everything, and it's hard to try to pay all the bills and keep insurance, and if they mess with marketplace insurance, we won't be able to afford insurance. “
Now that the Butcharts have met their deductible for the year, and with the prospect of losing their tax credits and choosing a lower-level insurance plan, the couple is trying to use insurance to buy as much equipment as possible that Sharden Butchart needs to treat her ALS before the end of the year.
That includes ordering a new wheelchair that Shadene Butchart can drive with her eyes, which could cost between $65,000 and $95,000, Doug Butchart said.
Doug Butchart said they may have to downgrade to a lower-level plan next year, but he's not sure if the medications his wife is currently taking will be covered by a “lower-level plan.”
A page from the Affordable Care Act health insurance website healthcare.gov appears on a computer screen in New York on August 19, 2025.
Patrick Thiessen/AP, File
Doug Butchart, a retired mechanic, said he feels lucky because he doesn't have to worry about a house or car payment — both are paid off — but there are other bills to pay and he didn't expect to struggle to pay his insurance every month.
“You work your whole life to make yourself comfortable, and I'm sure there are things we could do without doing that without so many crazy expenses that might require $1,500 a month for insurance,” he said. “That's a lot of money… You don't realize how important insurance is until you need it.”
'This is very worrying'
Nancy Murphy, a retired registered nurse and insurance industry employee, got Florida Blue coverage through the ACA for the first time this year.
She told ABC News her monthly premiums are $1,019, and the enhanced premium tax credit covers the total cost. If no deal is reached by the Nov. 1 open-enrollment deadline, or if the tax credits expire at the end of the year, she worries about being able to pay the fees.
“It's really concerning. I absolutely can't afford it if the tax credits expire,” said Murphy, 60, who lives in Fort Lauderdale. “As a Type 1 diabetic, it's a scary thought.”
Murphy said she uses an insulin pump to manage her diabetes and her insurance covers the disease with no out-of-pocket costs. However, she said she sometimes has other diabetes supplies for which she pays a total of $30 a month.
She added that losing the tax credit is a concern because she wants to make sure she can manage other expenses, including property taxes and her daughter's college tuition in Boston.
She said she was anxious about what her budget would look like without knowing exactly how much her premiums would increase.
“I was like stuck in a corner, and it was a really uncomfortable feeling,” Murphy said. “I like to budget and plan my budget. With tuition, property taxes and repairs that need to be made around the house, I need to have those listed.”
She continued, “These things make me very frustrated. We are American citizens. We should be able to use our tax dollars to pay for our health care needs.”