Health care is key for Democrats in shutdown fight. Here's what to know.

The federal government shut down early Wednesday following an acrimonious deadlock in Congress over spending in which Democrats have sought to put a spotlight on health care subsidies and who is eligible to receive coverage.

Senate Democrats rejected a Republican-led proposal that would have extended funding at current levels until Nov. 21, voting nearly along party lines. The shutdown is the first since January 2019, when President Donald Trump was previously in office.

Democrats had said they could not support a GOP-led funding extension until Republicans agreed to certain concessions on health care policy, primarily the continuation of pandemic-era Affordable Care Act subsidies that were set to expire by the end of the year.

Republicans countered those demands by falsely claiming that Democrats were trying to force the government to provide full health care benefits to undocumented immigrants.

Trump’s sweeping tax and immigration bill passed in July rolled back significant portions of the Affordable Care Act, popularly known as Obamacare, and Democrats had called for at least some of the cuts to President Barack Obama’s signature law to be reversed.

Here’s what to know.

What do Democrats say they want in the shutdown?

House and Senate Democrats argue that Trump’s One Big Beautiful Bill will increase health care costs for Americans, and they said they would use what leverage they have in the upper chamber to try to secure changes to provide relief for those affected.

In a meeting Monday with Trump, Senate Minority Leader Charles E. Schumer (D-New York) and House Minority Leader Hakeem Jeffries (D-New York) raised some key requests, including the extension of subsidies for those with insurance through the ACA marketplace that have been in place since the pandemic. They asked for those requests to be included in the funding bill and a guarantee from the White House not to unilaterally cut health care funding later.

Republicans, meanwhile, have said they are willing to negotiate on the ACA subsidy extension only when the government is open again. Moderates have pushed for the extension, but the more conservative members have vowed to block it, leaving the party split on the matter.

The impact of not extending the tax credits is likely to be felt widely: With the expiration of enhanced tax credits, ACA marketplace consumers’ out-of-pocket premiums will increase more than 75 percent on average, an analysis by health policy group KFF found. Separately, KFF found that insurers’ median proposed premium increase for 2026 to be about 18 percent, more than double last year’s median proposed increase of 7 percent.

Without an extension of the ACA subsidies, the nonpartisan Congressional Budget Office estimates that about 4 million people could lose insurance coverage over the next decade.

What do Republicans say about health care for undocumented immigrants?

Republican leaders have falsely repeated the claim that Democratic lawmakers are trying to force the government to offer full health care benefits to undocumented immigrants.

“The Democrats want Illegal Aliens, many of them VIOLENT CRIMINALS, to receive FREE Healthcare,” Trump said last week in a post on Truth Social. He added, “We cannot let this happen!”

Vice President JD Vance echoed that, saying on X on Sept. 25 that “Democrats are about to shutdown the government because they demand we fund health care for illegal aliens.” An X post from the Senate Republicans account showed an illustration of a ransom note with a list of purported “Democrat Demands,” including “Give illegal aliens free healthcare.”

Are undocumented immigrants eligible for federally funded health care?

Undocumented immigrants, as well as many legal immigrants, are already ineligible for most federal benefits.

According to HealthCare.gov, U.S. citizens, U.S. nationals and lawfully present immigrants are eligible for coverage through the Health Insurance Marketplace.

The website states: “Undocumented immigrants can’t get Marketplace health coverage. They may apply for coverage on behalf of documented individuals.”

Why do Republicans say Democrats want $1.5 trillion in spending?

Last month, Democrats presented their own government funding extension plan, ahead of the shutdown deadline. In a statement announcing the plan, Schumer said: “The legislation would address the health care crisis that President Trump and Republican lawmakers have single-handedly created by reversing the catastrophic healthcare cuts that would kick millions off their coverage and permanently extend the premium ACA tax credits.”

Their proposed plan sought to make the ACA subsidies permanent and reverse the $1 trillion in Medicaid cuts in Trump’s One Big Beautiful Bill.

The proposal to make ACA subsidies permanent would increase the deficit by almost $350 billion in the next decade and increase the number of people insured by 3.8 million, a Congressional Budget Office analysis concluded.

Republicans attacked the Democrats over their proposal - which also included language to increase oversight of administration spending authorized by the Congress and return millions of dollars to public broadcasting - describing it as a “$1.5 trillion ransom note to taxpayers.”

They also cast the shutdown as a deliberate ploy by the Democrats.