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At the heart of the government shutdown is a debate about health care, specifically about expiring subsidies for the Affordable Care Act plans. Republicans have long railed against the ACA. NPR congressional reporter Sam Gringlas looks at why some have now accepted that the law is here to stay.
SAM GRINGLAS, BYLINE: For weeks, Democrats have refused to back a government funding measure without an agreement to extend expiring ACA subsidies.
JEFF HURD: This is a big deal in my district. I've heard from a number of people that are facing dramatic increases.
GRINGLAS: That's Congressman Jeff Hurd, who says without the subsidies, constituents in his rural district could lose coverage. So it might come as a surprise that Hurd is a Republican. Like most in his party, he says reopening the government must come first, but he's also among the Republicans pressing to extend the subsidies, including Congresswoman Marjorie Taylor Greene. On HBO's "Real Time With Bill Maher," Greene criticized high ACA insurance premiums.
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MARJORIE TAYLOR GREENE: But here's the big problem - is it's about to skyrocket in January of 2025.
GRINGLAS: Fifteen years ago, when the Affordable Care Act passed with zero Republican votes, this kind of acceptance would have been hard to imagine. Former Republican House Majority Leader Eric Cantor says fights over the ACA fueled a 2013 government shutdown and helped birth the Tea Party and later, the Make America Great Again movement.
ERIC CANTOR: There was a lot of trepidation as to what Obamacare was going to mean, whether you were going to be able to keep your doctor, whether there were going to be death panels, and honestly, a concern about the unknown.
GRINGLAS: Over the years, Republicans repeatedly tried to repeal and replace Obamacare. Former GOP Congressman Fred Upton of Michigan helped work on an alternative.
FRED UPTON: We still faced opposition from within our own ranks. Here we are today, and there's still no alternative. It has been 15 years. It's not going to go away.
GRINGLAS: Even House Speaker Mike Johnson has acknowledged that Obamacare is unlikely to be repealed, and he and other Republicans, including President Trump, have struggled to articulate concrete reforms.
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MIKE JOHNSON: These ideas have been on paper for a long time. There's volumes of this stuff, volumes of it. We've been working on it since day one of this Congress.
GRINGLAS: Polls show a majority of Republicans still oppose Obamacare, but the law's popularity has been growing, and Ashley Kirzinger with KFF's Public Opinion program, says majorities favor extending the subsidies. More than half of ACA marketplace enrollees live in Republican congressional districts.
ASHLEY KIRZINGER: They are more likely to live in rural areas. They're more likely to own small businesses or be farmers.
GRINGLAS: A survey by Trump's pollster of competitive congressional districts backs up this support. Some Democrats hoped Trump would get involved and cut a deal to end the shutdown, even as most Republicans say they don't want to discuss the subsidies until the government reopens. Ahead of his Mar-a-Lago Halloween party last week, Trump did not seem to embrace the subsidies.
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PRESIDENT DONALD TRUMP: Obamacare has turned out to be a disaster, as I've been saying for years. It can be fixed or redone.
GRINGLAS: This view is still echoed by many Republicans, like Louisiana Senator Bill Cassidy, a gastroenterologist.
BILL CASSIDY: Obamacare has become the unaffordable care act, and the reforms that were supposed to lower health care costs are now being papered over with more and more subsidies.
GRINGLAS: Colorado Congressman Hurd agrees the subsidies only address a symptom of the exploding cost of health care. But for now, he says extending them is an imperative for him and many colleagues.
HURD: Whether it's something that they're public about or not, if you genuinely are serving your constituents, this ought to be something that's on your radar screen.
GRINGLAS: Hurd hopes this can be an opportunity for a bipartisan conversation about health care. But for more than a month, Congress has been unable to agree on a path to reopen the government. Overhauling the health care system would be even more fraught.
Sam Gringlas, NPR News, Washington. Transcript provided by NPR, Copyright NPR.
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