You Don’t Have to Be on the ACA to Feel the Collapse
How Subsidy Cuts Could Ripple Through Employer Insurance, Wages, and the Entire System
Congress may be shut down, but for millions of Americans, the real threat isn’t bureaucratic. It’s medical. While headlines focus on political infighting, the real reason Democrats are holding the line is because the future of the Affordable Care Act (ACA) subsidies is on the chopping block. And whether you’re on an ACA plan or not, this fight affects every one of us.
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What’s at Stake
So far, the GOP has refused to include ACA subsidies in the budget. Instead, they have argued for a “clean” continuing resolution, providing minimum funding and leaving all other concerns for separate legislation.
Democrats are pushing hard for the budget to include the reauthorization or extension of these subsidies in the CR, recognizing that failure to include them now likely means that no future legislation will be passed either.
So what are enhanced ACA marketplace subsidies? Put simply, they are the tax credits that make coverage affordable for those who rely on ACA plans. They are set to expire at the end of 2025.
These subsidies were expanded under the American Rescue Plan and the Inflation Reduction Act, lowering premiums for millions of low- and middle-income Americans, in part recognizing that, under the US medical insurance system, companies have regularly raised prices despite wages not increasing to offset the cost.
Without renewal, premiums could double or triple for many, and millions could lose coverage outright.
Why This Matters, Even If You’re Not on an ACA Plan
One in seven Americans has used the ACA Marketplace since its creation. A Kaiser Family Foundation (KFF) summary states that in 2025, Marketplace enrollment reached approximately 24.3 million. This includes those who are self-employed, work in the gig economy or as contractors, or are not covered by an employer plan due to part-time status or because their employer does not provide one. Since the ACA’s inception, these plans have covered 49.4 unique individuals.
Losing these subsidies would be a huge burden for those who rely on the marketplace. However, the damage extends far beyond the marketplace.
More Uninsured Means Higher Costs for Everyone
When millions lose access to affordable health insurance, they don’t just stop getting sick. Instead, they stop going to the doctor. They avoid check-ups. They wait until their conditions become emergencies. And when they finally do seek care — in the ER, the most expensive place to treat anything — the costs don’t disappear. Hospitals still have to pay for those visits, and that cost doesn’t stay on the books. It gets passed along to the rest of us through higher hospital prices, bigger premiums, and bloated deductibles in private insurance plans.
So even if you’re not enrolled in the ACA, you’re paying for its unraveling, whether through your next premium hike or that surprise bill for your kid’s broken wrist.
A Sicker Marketplace Means Higher Premiums for Everyone
ACA insurance markets are like any other insurance system: they depend on large, diverse pools of people, including healthy ones, to balance the cost of care for those who are sick. When subsidies disappear, healthier people, especially younger adults, often drop their coverage because they can’t afford it. That leaves behind a smaller, sicker pool of people, which makes coverage more expensive for everyone who stays.
Think about flood insurance. It is a safe, profitable gamble at high altitudes and in areas not prone to flooding. The company collects premiums but rarely has to pay out. However, an area with a history of flooding will have access to fewer insurers (because many companies consider it an unsafe bet) and will pay more for coverage (due to less competition) because the likelihood of the insurer having to pay out increases. Medical insurance works the same way.
Insurers respond by raising premiums or exiting the market entirely. As ACA plans become more expensive and less available as companies pull out, insurers may raise prices elsewhere, including in employer-sponsored coverage, where many of those same companies also operate.
What happens in the ACA doesn’t stay in the ACA.
Your Employer Is Already Using “Insurance Costs” to Hold Back Raises
Ask any HR department why salaries aren’t going up, and one of the first answers is almost always, “healthcare costs.” Year after year, companies blame ballooning premiums for stagnating wages. And they’re not wrong. The cost of offering coverage is rising faster than inflation or revenue for many businesses. For small businesses, the burden is often insurmountable.
That’s exactly why it matters that ACA subsidies are renewed. The subsidies help stabilize the individual insurance market, keeping insurers solvent and helping hold back some of the pressure on the employer market. When the ACA loses its footing, the pressure shifts to employers —and ultimately to workers —who are told their raises are sitting in a spreadsheet labeled “healthcare.”
Even the threat of the subsidies ending has shaken some employers. Each year, budgeting is already a struggle as costs regularly rise, but now, by how much is largely unknown.
The Myth of the “Separate” System
It’s easy to think of the ACA and employer-based insurance as two entirely different systems. However, they are more like two rooms in the same house, built by the same architects, managed by the same insurers, priced by the same pharmaceutical and hospital giants. When the ACA is destabilized, insurers have to protect their margins elsewhere. Often, that means squeezing employers or shrinking networks. The “separate systems” narrative only exists to shield the truth: every insurance plan is part of the same fragile ecosystem, and when one side collapses, the rest shakes.
You’re Next
Right now, you might have good coverage. Maybe it’s through your job. Maybe you haven’t needed to use it much. However, the distance between “insured and secure” and “on the ACA and scrambling” is shorter than we think.
One shift in your life, and suddenly the ACA marketplace is your only lifeline. A layoff, a divorce, a diagnosis — one change and the entire outlook can change. That’s true today, and it will be even more true tomorrow if employers, facing growing cost pressures, begin moving full-time staff to part-time status just to avoid offering benefits. It’s been happening in retail, food service, education, and logistics for decades. If premiums spike because subsidies vanish, it will become the norm.
This is why the idea that “someone else’s coverage” doesn’t concern you is not only morally bankrupt but also economically delusional.
No One Should Go Broke From a Medical Bill
This is the heart of what we believe, and it’s why this shutdown matters so deeply. You can do everything right — work hard, pay your premiums, follow your doctor’s advice — and still get hit with a bill you can’t afford. That’s not freedom. That’s not a functioning system.
The ACA isn’t perfect, but it’s a critical pillar of protection for tens of millions of people. When Democrats fight to preserve its subsidies, they’re not “playing politics.” They’re protecting your ability to go to the doctor without risking bankruptcy.
This isn’t about abstract budget numbers or cable news spin. It’s about the kitchen table reality of health care in America. If we let those subsidies expire, we’re not just shutting down the government. We’re shutting down affordable care for families everywhere.
This isn’t a budget debate. It’s a question of whether health care is a right or a privilege tied to your employment status and income. And in this system, where you can do everything right and still drown in bills, Democrats are demanding that we don’t make it worse by gutting the ACA when people need it most.
Yes, This Is Why We Need A Better System
Let’s get ahead of the inevitable (and correct) response: “This is why we need universal healthcare.” Call it Medicare-for-All, call it a One-Payer System. Whatever the model, whatever the label, we need something else.
What’s happening with the shutdown and ACA subsidies is not a glitch in the system. It is the system. It’s a system where access to care is fragmented, overpriced, and intentionally complicated, where corporate profit takes precedence over public health.
And when we compare this reality to the rest of the developed world, it becomes painfully clear: we are being scammed.
The Only Winners Are the Corporations
The biggest players in American healthcare — private insurance giants, pharmaceutical companies, hospital chains — are posting record profits year after year.
UnitedHealth Group made over $24 billion in profit last year.
CVS Health (which owns Aetna) pulled in over $8 billion.
CEOs routinely earn tens of millions in compensation annually.
Meanwhile, insurers spend tens of millions lobbying to block reform, and almost nothing is actually improving access to care.
These companies make money by denying care, narrowing networks, jacking up prices, and keeping everything as fragmented and opaque as possible. They profit whether you get better or not. They profit more when your care gets delayed, denied, or deflected onto another payer.
The Rest of the World? They’ve Figured It Out.
In countries like the UK, France, Canada, Australia, Germany, and Japan, the system looks very different. Everyone has healthcare. There’s little to no medical bankruptcy.
In the US, employer and employee costs approach and sometimes exceed $30,000/year in premiums and out-of-pocket costs just to be “insured.” However, in other nations, employers may pay little or nothing for plans, and the cost per person is less than half of what the U.S. spends.
They also achieve better outcomes in areas such as life expectancy, infant mortality, and chronic disease management. Because coverage is rarely tied exclusively to employment, people can leave jobs, start businesses, raise families, and get divorced without losing access to care.
They don’t have to “shop for plans.” They don’t worry about “networks.” They just go get care and get on with their lives.
Are their systems perfect? Of course not. Even in strong universal systems, dental, vision, and hearing care are often not given the same priority as hospital care or doctor visits. That said, those systems do much better than ours in making those services accessible, affordable, and regulated. In contrast, in the U.S., dental and vision and hearing care have become the “wild west” of health services—fragmented, tied to employment, and treated as optional extras rather than fundamental care.
However, based on every outcome and cost metric, they are drastically better.
Our Problem Isn’t “What We Can Afford.” It’s What We Allow.
The U.S. spends more than any other country on Earth for healthcare, but instead of using that to create a system that works for all of us, we funnel it through layers of for-profit corporations that exist to extract value, not create health.
So yes, this shutdown is about ACA subsidies. However, the reason that fight even exists is because we built a healthcare system that puts profit at the center, not people.
And the people who benefit from that system will spend whatever it takes to keep it that way, until we stop letting them.
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Sources:
“Get the Facts: Health insurance expected to rise if tax credits expire amid government shutdown” – KCRA News, Oct 22, 2025.
“How Much More Would People Pay in Premiums if the ACA’s Enhanced Subsidies Expired?” – Kaiser Family Foundation (KFF).
“Over 24 Million Consumers Selected Affordable Health Coverage in ACA Marketplace for 2025” – Centers for Medicare & Medicaid Services (CMS)
“Enrollment Growth in the ACA Marketplaces” – KFF, 2025.
“How Much and Why ACA Marketplace Premiums Are Going Up in 2026” – Peterson‑KFF Health System Tracker.
“Who Might Lose Eligibility for Affordable Care Act Marketplace Subsidies If Enhanced Tax Credits Are Not Extended” – KFF.
“Providers Face $32 B Revenue Loss Amid Stalemate on ACA Subsidies” – HealthLeaders Media.
“Will Employers Drop Health Insurance Coverage Because of the ACA?” – PMC/NCBI (National Library of Medicine).
“Expiring ACA Premium Tax Credits Could Lead to Nearly 340,000 Jobs Lost Across the U.S. in 2026” – The Commonwealth Fund (Oct 16, 2025).
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Medicare for everyone is a great solution
Brilliant.