Bob Sheak

Reasons for and effects of the government shutdown

The country is in shutdown because the Democratic Party wants to ensure that the Affordable Care tax credits are extended, while Trump and the Republicans refuse to discuss the issue until the government is opened. However, whenever it comes to a vote, the Republicans are expected to reject the Democratic proposal.  

Selena Simmons-Duffin writes for NPR that the tax credits make “ACA [Affordable Care Act] health care premiums affordable for many Americans” (https://npr.org/1025/10/12/nx-s1-5570849/shutdown-aca-health-care-tax-credits}.

She explains. “The tax credits that make ACA health care premiums affordable for many Americans don’t expire until December, as Republican lawmakers note. But Democratic lawmakers want to see them extended before enrollment begins Nov. 1, and they have made that a condition of voting to reopen the government.” The Democrats fear that Trump and the Republicans will not extend the tax credits, which otherwise continue into 2026.  

“It’s not just a battle over political messaging,” Simmons-Duffin writes. “These are real health insurance marketplaces where real people — 24 million of them — buy coverage. The amount the federal government picks up for their monthly premiums makes a big difference.” She identifies “5 things to know about the healthcare fight behind the shutdown.” (1) She refers to polls indicating that a majority of respondents favor extending the tax credits. (2) The issue is urgent since open enrollment starts Nov. 1. (3) Premiums are set to shoot up next year.

(4) “When researchers at KFF analyzed 2026 insurance filings, they found that premiums will double for many consumers next year. ‘On average, we’re expecting premium payments by enrollees to increase by 114% if these enhanced tax credits expire,’ says Cynthia Cox, director of the Program on the ACA at KFF.

Sky-high premiums might drive people to risk it and go uninsured, she says. The Congressional Budget Office estimates that 4 million people will become uninsured in the next few years if the enhanced tax credits expire.”

(5) “The subsidies are expensive for the government. The subsidies that kept costs down for consumers cost the federal government a lot of money. The Congressional Budget Office estimates it would cost the government $350 billion over the next decade if the enhanced subsidies were extended permanently.”

Simmons-Duffin adds: “Conservative groups that have always opposed the Affordable Care Act are against the enhanced subsidies. A coalition of groups recently argued in a letter to the president that the enhanced tax credits were meant to be temporary during the COVID-19 pandemic and that extending them will exacerbate rising health care costs.” They dismiss the harm that will cause so many people to be priced out of the healthcare market.

One of the principal arguments invoked by the Republicans is that the national debt of some 37 trillion dollars makes it irrational to add more to that debt. The truth is that Republican President and Congress are principal actors in raising this debt. Their tax cuts for the rich are so much greater than the tax-credit issue now at stake makes their argument ridiculous. Consider the following evidence reported on April 10, 2025 (https://budget.senate.gov/ranking-members-newsroom/press/news-cbo-analysis-shows-republican-tax-giveaways-add-52-trillion-to-national-debt-over-30-years).

“At the request of U.S. Senator Jeff Merkley (D-OR), Ranking Member of the Senate Budget Committee, the independent, nonpartisan Congressional Budget Office (CBO) released a new projection showing that the tax giveaways in the Senate Republicans’ budget proposal will add $52 trillion to the national debt over the next 30 years. The previous projection for the cost of extending the Trump tax law and the Republican leadership’s attempt to use a budget gimmick, known as “current policy baseline,” was $37 trillion over the 2024-2054 period.

This new projection follows recently released data from the Joint Committee on Taxation showing a new estimate that the Republican plan to extend the 2017 Trump tax law will cost $5.5 trillion including interest over the next decade. The budget resolution Senate Republicans passed last week allocates an additional $1.5 trillion for tax giveaways. This brings the total potential 10-year cost of the Republican tax plan, which will overwhelmingly benefit the wealthy and corporations, to more than $7 trillion. 

“It has taken over 249 years, since the Founders signed the Declaration of Independence on July 4, 1776, for the U.S. to accumulate nearly $37 trillion in debt – and today the Republicans want to use a budget gimmick to add an astronomical $52 trillion to our debt with one bill with one intention: to fund massive tax giveaways for billionaires,” said Senator Jeff Merkley, Ranking Member of the Senate Budget Committee. “For 30 years, Republicans have been changing the rules to give tax cuts to the wealthy – and families have been stuck paying the bill. Republicans who claim to care about fiscal responsibility should be outraged and doing everything they can to stop it. This is the Great Betrayal of working families across the country.”

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The current Republican agenda is far-reaching

The current political fight reflects a broader goal of the Trump administration, namely, to diminish the size and power of the federal government generally and to create a presidency with extraordinary power, that of a “king.” Coral Davenport and her colleagues provide a detailed and insightful analysis of this anti-democratic vision (https://nytimes.com/2025/09/29/us/politics/russel-vought-trump-budget.html). She highlights the role of Russel Vought, the White House budget director, in this project. Vought is a central figure in Trump’s administration when it comes to budget issues. Here is just a little of what Davenport writes.

“Now Mr. Vought, 49, is leveraging the shutdown of the federal government to further advance his goals of slashing agencies and purging employees. In a series of social media posts on Thursday, Mr. Vought said the administration had delayed or halted about $8 billion in what he called “Green New Scam funding to fuel the Left’s climate agenda,” a move that affects projects in 16 states, most of which are led by Democrats. He also paused about $18 billion in approved infrastructure funding for two major transportation projects primarily in New York City, whose state delegation includes Senator Chuck Schumer, the Democratic leader, and Representative Hakeem Jeffries, the House minority leader.

Just before the shutdown, Mr. Vought’s office had told agencies to prepare for mass firings unless Congress could strike a deal to keep the government open.”

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 US Healthcare System Is in Crisis

James K. Elsey, MD, FACS analyzes how the US health care system as a whole is in crisis (https://facs.org-articles/bulletin/2025/february-2025-volume-110-issue-2/us-healthcare-system-is-in-crisis). The article was published on Feb. 5 of this year. Dr. James Elsey is a professor of surgery at the Medical University of South Carolina in Charleston, and Past Vice-Chair of the ACS [Affordable Care Act] Board of Regents.

Bear in mind, Trump, Vought, and the Republicans want to cut overall government healthcare spending, along with other government programs they don’t like.  

Here is some of what Elsey writes.

“During my 44 years of active surgical practice, I have witnessed numerous, significant, and onerous progressive changes that threaten the quality, safety, accessibility, and affordability of medical care in this country. Sadly, it has evolved into a highly corporatized system controlled by a decreasing number of increasingly powerful conglomerates where profit is often the main metric of performance and success. The stark realities of this dark devolution create daily difficulties for patients trapped in this harsh and inequitable system.”

His patients are commonly more concerned about the costs of a procedure. They ask: “How can I pay for this? Will I lose my house or my job? How fast can I get back to work?,” followed, all too frequently, by comments like: “There is no way I can afford this. I don’t have access to that level of deductible. This will bankrupt me.” And, periodically, they would come to this decision: “I just can’t proceed, doctor. This will put my family in the street. I’ll just tough it out and take my chances.”

Elsey continues. “There is something deeply and fundamentally wrong with this increasingly common situation where the accessibility of healthcare, which I believe should be a basic human right, is determined by one’s financial station in life. For this to be occurring in the most affluent country in the world is not just wrong, but in my opinion, abjectly amoral.”

“This system leaves too many people out resulting in 26 million uninsured and 43 million underinsured.³ In fact, recent World Health Organization metrics suggest that the US does an incredibly poor job with healthcare delivery, with the US ranked 37th overall to comparable Western country metrics and last among the 11 highest-income countries.⁴ These rankings are not surprising when you consider the fact that the US healthcare delivery system consumes 17% of our current gross domestic product and is the leading cause of personal bankruptcy accounting for 66.5% of total US individual monetary defaults.^5,6

Placing Profits over Patient Care

“The US healthcare system handicaps business competitiveness with a crippling 160% increase in employer healthcare costs in the last 20 years, which averages about $14,000 per employee.” Elsey writes.⁷ “This system also causes downward pressure on employee wages resulting in a 8.9% inflation adjusted decrease in employee household income.⁸ In addition, it requires many Americans and their families to line up in fields for humanitarian healthcare events mirroring the activities of many third-world countries as well as requiring increasing numbers of citizens to use the ER as their default medical care.

“This default is fragmented, costly, inefficient, and a generally poor method of providing care with a total lack of continuity. This healthcare model also drives significant racial disparities in the availability and quality of care, and in the outcomes for these patient populations.

“Currently the US, compared to similar Western countries [all of which have some form of universal healthcare] has the lowest life expectancy at birth, highest reported maternal and infant mortality, highest hospitalization rate from preventable causes, highest death rate for avoidable and treatable conditions, highest suicide rate, and highest chronic disease burden rate in the world.⁹

“Our system lacks an emphasis on primary and preventive care. We strain under a dysfunctional payment system. It is plagued by a costly and onerous liability industry, and it has fallen prey to the detrimental policies of the medical industrial complex and corporatized care.”

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Concluding Thoughts

The Trump-Republican justification for not negotiating on an end to the shutdown reflects a dubious view of the causes. Rather than suggesting that their phony concern with the nation’s fiscal issues is what drives them, the evidence indicates they want what right-wing politicians have always wanted, less government spending on healthcare and other programs for Americans, expansive deregulation, and any other policy to improve profits for big corporations and the rich.