Democrats: Use Funding Fight to Stop the Republican Assault on Health Care

As Congress barrels toward another funding deadline, Democrats are again debating how to navigate it. Given President Trump’s all-out assault on our democracy, the constitution, the rule of law, governing norms, and simple decency, there are plenty of things Democrats could demand in return for their appropriations vote.

But while there are many targets and outrages, Democrats must train fire on the ones most pertinent to Americans and most sensitive to swing-state and swing-district Republicans. That battleground is clear: health care costs. Republicans just passed the largest cuts in history to Medicaid, kicking millions of working-class Americans off their health care. Already, a supermajority of Americans view the law unfavorably, and nearly half of adults say the signature Republican law will hurt them. But the GOP’s Medicaid cuts are just part of their attack on health care. Republican cuts already are shuttering rural hospitals, which also will ravage already over-burdened emergency rooms. And Republican refusal to extend the enhanced Affordable Care Act (ACA) premium tax credits means middle-class families will face a giant spike in health care costs.

This is the rare shutdown fight in which the policy, politics, and leverage all align. Democrats should make health care costs their non-negotiable demand. They should refuse to participate in a bipartisan effort to fund the government unless the GOP solves the health care cost crisis they alone caused. That means, at a minimum, Republicans agree to cancel Medicaid cuts, permanently extend the ACA cost protections, and protect veterans’ care. If Republicans want to continue in their efforts to yank health care away from millions of Americans and massively increase costs, they should be forced to fund the government on their own through a partisan budget reconciliation process.

The Stakes: A Massive Health Care Price Hike

The most sweeping Republican actions were of course the huge cuts to Medicaid in the OBBBA. They slashed $1 trillion over the next decade. In addition to millions losing insurance protections, nursing homes, community health centers, and physician practices will face significant losses. These providers often operate on razor-thin margins when taking care of Medicaid patients. For rural hospitals, these cuts will be especially catastrophic, forcing closures across the country. Rural hospitals alone could see $115 billion in direct losses from Medicaid reductions before even accounting for the indirect fallout like spikes in uncompensated care due to an estimated 8 million people losing their health coverage.

The other big-ticket item is the looming expiration of the ACA premium tax credit. Marketplace plans are projected to rise by an average of 18.5% in 2026. In Virginia, families are already seeing notices of increases above 20%, while in Maine the hike could reach 32%. These are not abstract figures—they will be bills landing in mailboxes soon. Independent estimates project out-of-pocket costs for insurance will rise by about $700 per person per year, an increase of more than 75%. For a typical middle-class family of four, the cost increase will be more than$8,000—at a time when many are struggling with Trump’s tariff-driven inflation that is jacking up prices on everything from groceries to household goods.

The Politics: Health Care as a Strength for Democrats

Some Democrats worry that holding the line in a funding fight and causing a shutdown risks political blowback. And while we agree with commentators who say it’s a risk worth taking, we do not think that most of Trump’s depredations, including the absurd and dangerous militarization of Washington, DC, is fertile political territory for Democrats. That’s the fight Trump wants the party to pick.

Instead, Democrats should fight to protect middle-class health care. That is the one area where they consistently have the upper hand. Because the ACA itself is now quite popular, with two-thirds of Americans viewing it favorably. That is a higher rating than either the Pope or Taylor Swift.

Republicans are on the wrong side of both substance and perception. Their signature achievement this year is a gigantic tax cut for the wealthy, while massively increasing the deficit. Now they are effectively pushing a middle-class tax hike by blocking health care subsidies.

Polling confirms this is political quicksand for Republicans. Third Way’s recent survey found that messages about Republicans slashing $1 trillion from Medicaid—cuts that would harm children, people with disabilities, and working families—resonated strongly with Independents and even persuadable Trump supporters. Layer on top of that a looming premium increase of 20% to 30%, and the contrast between the parties could not be clearer. Trump’s own pollster warned that if a Republican lets the tax credits expire, they will trail the Democrat by 15 points. Democrats have an opportunity here to fight to extend a middle class tax credit supported by 91% of Democrats, 80% of Independents, and even 63% of Republicans.

The Strategy: Dig in to Protect Middle Class Families

Health care costs are a significant burden on Americans—especially those from lower- and middle-income families. Since 2000, health care costs per capita have more than tripled.

Obviously, most voters do not know or care about the mechanics of appropriations bills or continuing resolutions. They are focused on whether government is delivering for them. If voters can’t afford health care next year, if they can’t see their doctor, or the quality of their care gets worse, then government surely is not working.

That’s why Democrats must draw a red line on GOP cuts to the cost protections in the ACA, access to rural and essential care through Medicaid, and veterans’ health care. If Republicans are hellbent on denying care to millions, let them fund the government alone.

If Democrats remain united around this singular goal, they either will succeed in protecting Americans from massive cost hikes or they will show the public they are the only party fighting to keep health care affordable. Both outcomes are wins.