On November 12, 2025, lawmakers passed a bill to temporarily fund the federal government, ending a 43-day shutdown, the longest in U.S. history.¹ The spending bill only funds the entire government through January 30, 2026, raising the prospect of another shutdown fight. This Health Capital Topics article provides an update on the ongoing saga.

Congress passed the most recent temporary funding bill, known as a continuing resolution (CR), on March 14, 2025, funding the government through September 30, 2025.² However, at the end of September, Senate Democrats refused to vote for a spending bill that did not renew the Affordable Care Act (ACA) marketplace enhanced premium tax credits.³ Senate Republicans have a narrow majority, but require Democratic backing to meet the 60-vote threshold needed to pass extensions.

The ACA marketplace enhanced premium tax credits, which are provided ) buter-income individuals to purchase health insurance on the ACA insurance exchanges, and have been in place since 2021, are currently set to sunset at the end of 2025.⁴ The Urban Institute estimates that if the ACA enhanced premium tax credits ultimately expire, 22 million Americans would see increased health insurance costs, and healthcare providers would lose $32.5 billion in revenue and take on an additional $7.7 billion in uncompensated care costs in 2026.⁵ Democrats pushed to include an extension to the tax credits in the One Big Beautiful Bill Act (OBBBA), but were unsuccessful. Without the enhanced ACA subsidies, ACA marketplace plan premiums are expected to more than double in 2026.⁶

While the most recent stopgap funding bill reinstated COVID-era telehealth flexibilities though January 30, 2026, it did not include an extension of the enhanced ACA subsidies.⁷ However, the seven Democratic (and one Independent) senators voted with Republicans to pass the spending bill in exchange for a vote on the ACA subsidy extension by mid-December.⁸ Notably, the House has not committed to bringing it to the floor for a vote in that chamber.⁹ In response, House Democrats introduced a discharge petition aimed to force a floor vote on legislation to extend ACA subsidies for three years.¹⁰ Additionally, 14 centrist House Republicans support legislation introduced by Rep. Jen Kiggans (R-Va.) that would extend the ACA subsidies for one year; whether those lawmakers would support the Democrats’ discharge petition is unknown.¹¹ Nevertheless, subsequent legislative hearings and comments from lawmakers indicate that even a one-year extension of the ACA subsidies is increasingly unlikely.¹²

In the face of open enrollment on the ACA exchanges and the upcoming Senate vote, and worried about potential blowback in the 2026 midterm elections, the Trump Administration is privately discussing potential White House alternatives to the ACA subsidies.¹³ Potential alternatives discussed include “giving money directly to Americans to cover health expenses and subsidizing out-of-pocket costs for low-income people enrolled in the ACA.”¹⁴

Healthcare trade associations have called on federal lawmakers to vote on extending the ACA subsidies. AHIP (formerly America’s Health Insurance Plans) CEO stated:

“While open enrollment is well underway, there is still time to protect 24 million Americans from the largest-ever increase in health care costs in 2026. Maintaining the health care tax credits will bring immediate relief to millions of working families, sole proprietors, small business employees and rural Americans who face an acute cost-of-living crisis in 2026 if Congress fails to act.”¹⁵

The executive vice president for public affairs at the Federation of American Hospitals added that extending the ACA subsidies is “the only mechanism to immediately cut costs for hardworking families already struggling to make ends meet.”¹⁶ The Blue Cross Blue Shield Association added that “[w]ithout an extension, millions will be priced out of the individual marketplace, while millions of others will see their monthly premiums double or worse. We urge bipartisan leaders from both sides of the aisle to come together to ensure this financial lifeline makes health care affordable in 2026 and beyond.”¹⁷

In addition to support from the healthcare industry, the American public supports extending the subsidies; a recent Kaiser Family Foundation poll found that “74% of voters support an extension—this includes 94% of Democrats, 76% of independents and 50% of Republicans.”¹⁸

The end of the 43-day government shutdown resolves the immediate crisis but leaves the fundamental dispute over ACA enhanced premium tax credits unresolved and any resolution less and less likely. The temporary nature of the funding bill – extending only through January 30, 2026 – ensures that healthcare policy debates will remain prominent in the near term. The promised Senate vote on ACA subsidy extension by mid-December, coupled with the House discharge petition and emerging White House alternatives, indicates that multiple pathways remain under consideration. However, the political dynamics that led to the record-length shutdown suggest that resolution may prove challenging, and the prospect of another funding deadline in late January adds an additional layer of uncertainty to an already complex policy landscape.