What ACA subsidy expiration means for Iowa families as shutdown looms

Iowa Democrats warned Friday that tens of thousands of Iowans could face skyrocketing health insurance premiums or lose coverage altogether if Republicans in Congress fail to extend expiring Affordable Care Act tax credits.

Iowa Democratic Party chair Rita Hart said GOP leaders are playing politics with a vital program that helps families afford coverage. The enhanced ACA subsidies, first expanded during the COVID-19 pandemic, are set to expire at the end of the year unless Congress acts.

"We have a growing health care crisis that is facing Iowans," Hart told reporters during a Friday morning press call.

"Republicans would rather shut down the government than work with Democrats to solve a growing health care crisis for their constituents," Hart said, calling out Iowa Republican U.S. Reps. Zach Nunn, Mariannette Miller-Meeks, Randy Feenstra and Ashley Hinson.

A central sticking point in negotiations to avert a partial shutdown is whether to extend the expiring health insurance subsidies that cap monthly insurance premiums for those who buy insurance through the Affordable Care Act marketplaces.

The House last week approved a Republican stopgap spending measure that would maintain current funding levels through Nov. 21, giving lawmakers time to negotiate a full-year budget. But the bill stalled in the Senate, where Democrats instead pushed a shorter four-week plan that also tacked on a permanent extension of Affordable Care Act subsidies and other provisions Republicans dismiss as non-starters.

"I proudly voted to pass a clean (continuing resolution) that keeps the government open and protects vital services for our military, veterans and seniors," Miller-Meeks said in a statement to The Gazette. "Democrats are holding the government hostage to demand taxpayer-funded health care for illegal immigrants. We've done our job, it's time they do theirs."

Nunn echoed Miller-Meeks.

"Democrats just voted down a measure to keep our government open. No amount of gaslighting or spin can change that, and the impact on Iowa is real: service members will miss paychecks, families could lose SNAP benefits, and farmers will lose access to disaster loans in the middle of harvest," Nunn said in a statement. "Iowans are tired of political games. It's time for Iowa Democrats to tell their friends in D.C. to pass the bill I supported to keep our government open."

Families brace for higher costs

Hart was joined by two Iowans whose families rely on the ACA or Medicaid for coverage. Both painted stark pictures of what inaction could mean.

Nick Larson, a farmer from Walker, said his family of five buys coverage through the ACA marketplace after he retired early from a corporate job after 27 years to focus on his small farming operation. His wife also retired from a 33-year teaching career in 2024.

"The ACA allows millions of self-employed Americans like me to use tax credits to offset the increasing cost of health insurance for their families," Larson said.

He said the family buys a high-deductible plan and pays around $400 per month, comparable to what they paid under employer-sponsored plans.

Larson said the family pays nearly $13,000 annually between premiums and out-of-pocket costs. Without the tax credits, he said, their costs could soar.

"Our family will realize an immediate tax increase of at least $3,000 per year. Since our current income is near what's called the ACA 'cliff,' our taxes could increase over $15,000 per year," Larson said. "Open enrollment starts before this could be negotiated in Congress. So the way this is dragging out, it's going to be way past time where we have to make decisions, unless we act immediately."

Larson said he has repeatedly sought help from Hinson, a Republican from Marion, including raising the issue at a town hall in May.

"I'm for protecting access to health care, keeping premiums down, and keeping the government funded and open," Hinson said in a statement. "Democrats are playing political games and risking all three. I support a solution to ensure Iowans have certainty and will work with my colleagues on both sides of the aisle to lower health care costs while expanding access to care."

Terry Anderson, a veteran from Ankeny, shared his experience caring for his 39-year-old son, who has cerebral palsy and blindness and relies on Medicaid. Anderson said stagnant reimbursement rates for providers have led to staff turnover and declining services, leaving families like his stretched to the breaking point.

Anderson, who has neuropathy himself, said he can no longer safely care for his son without support.

"Everything in his life is with assistance — whether it's feeding, because he's blind and has cerebral palsy. He's speech apraxia, so he can't communicate clearly," Anderson said.

If Congress fails to extend the enhanced Affordable Care Act subsidies, Iowans could see steep hikes in their health insurance premiums, according to an analysis by health policy organization KFF.

A 60-year-old couple making $82,000 would see their monthly benchmark premium jump from about $581 to about $1,800 — an increase of more than 200%. A 40-year-old making $31,000 would see their monthly cost rise from $58 to $153.

Roughly 100,000 Iowans rely on subsidies to afford ACA coverage, and without them, KFF warns, many could be priced out of the marketplace altogether.

Cancer survivor says losing tax credits would mean no coverage

Lori Hunt, 53, a breast cancer survivor from Des Moines, lost her nonprofit job in late 2024. She now relies on premium tax credits to afford health insurance that covers costly screenings, MRIs and prescriptions. With the credits, she pays just $8 a month. Without them, her premiums would spike to between $650 and $750 — more than her mortgage.

"I could not afford it. I could not. I would have to cancel it," Hunt said, which would mean putting off care and the kind of screenings that helped her catch cancer early.

"If I put that off for two years and maybe I'll miss something, you know, that's so small you can't feel it," she said. "Not a very cheery thing to think about."

The uncertainty is weighing on her as open enrollment approaches. She worries not only for herself but also for thousands of others in Iowa — farmers, small-business owners and people working multiple jobs without benefits — who could be priced out of coverage.

"Once people start losing access to health care, that increases costs for everyone," Hunt said. "All those costs get passed on to everyone else. … At the end of the day, we should be working to make health care more accessible and affordable, just full stop."

Hunt said she wants Congress to "do its job" and negotiate a bipartisan plan to keep coverage within reach.

Ankeny mother says rising premiums, lost tax credits could squeeze small-business families

Amber Gustafson, 48, lives in Ankeny with her three children and her husband, who runs a small manufacturing equipment company employing about 10 people. They rely on ACA tax credits to afford high-quality health insurance, including for two children with disabilities.

They receive a $250 monthly tax credit to help offset their premiums. But with Blue Cross Blue Shield set to raise rates by 12% next year, they face a $500 monthly increase if the subsidies expire.

"This will be a pinch for our family, for sure," Gustafson said. "We'll feel it. But at the same time, we're not going to give up health insurance."

She said they've already begun cutting expenses, dropping their gym membership and other nonessentials, and may have to move to a plan with higher deductibles.

Gustafson called on lawmakers to recognize the strain facing small-business owners who shoulder the full cost of family health insurance.

"It's such a betrayal of what they claim their values are," she said, adding if someone's diabetic or has another chronic condition, how are they ever supposed to start a business if they can't afford coverage?

Gustafson, a Democratic activist, urged her party not to back down in negotiations.

"I hope the Democrats hold strong," she said, acknowledging that while a shutdown "is not good for anybody," Democrats must "hold the line on health insurance for people."

Blame game over shutdown

Hart placed responsibility for any shutdown squarely on Republicans.

"Let's remember Republicans control the House, the Senate and the White House," she said. "If the government shuts down, that's on them for failing to come to an agreement."

Hinson and the White House this week pushed back on Democratic criticisms, arguing it is Democrats who are steering the country toward a shutdown. In a statement, officials accused Democrats of "threatening to hold government funding hostage to score political points, ignoring the real-world consequences."

National outlets have reported that Democrats are taking a hard line. Politico noted Democrats are using the shutdown fight as leverage to secure a permanent extension of Affordable Care Act subsidies, while Republicans have proposed a "clean" seven-week continuing resolution to keep funding flowing and allow more time for negotiations. The New York Times reported Senate Democrats blocked the GOP bill to fund the government through November, demanding health care concessions.

Other outlets framed the battle as a political gamble. CNN described Democrats as "eager for a fight with Trump," while Bloomberg said Senate Majority Leader Chuck Schumer is under pressure from his caucus to risk a shutdown after backing down earlier this year.

Asked whether Democrats would accept a short-term extension of ACA tax credits in exchange for a deal to keep the government open, Hart said Democrats want a permanent solution but emphasized that the immediate priority is preventing families from facing sudden spikes in premiums.

"We would like to see a permanent solution, because these are problems that are not going away," she said. " … We've got a deadline coming up. So what (families) want is a solution that at least doesn't make these premiums go up in the short term and that they're working on a long-term solution."

Larson, the Walker farmer who shared his family's story, added that a single-year extension would not resolve the "ACA cliff" issue that could leave families like his facing thousands of dollars in unexpected costs if their income rises slightly above the eligibility threshold.