The shutdown deal does not extend health benefits that expire. What happens to them now?

NEW YORK (AP) — A legislative package that appears poised to end the longest government shutdown in U.S. history ignores any clear resolution on expiring tax credits under the Affordable Care Act that made private health insurance less expensive for millions of Americans.

Instead, the deal approved by Senate Republicans and a handful of Democrats on Sunday only guarantees a vote in December on the enhanced tax breaks, which are set to expire at the end of the year without action from Congress.

Even then, House Speaker Mike Johnson, R-Los Angeles, has not agreed to a similar vote in the House on the issue, making the chances of an extension increasingly bleak.

Watch live: The Senate is expected to vote on the government shutdown deal

Some Democratic lawmakers looking to compromise have sought stopgap measures for a year or two that would keep the benefits alive, but have failed to win support from Republican leadership.

Meanwhile, some Republican lawmakers and President Donald Trump have argued in favor of letting the benefits expire and have proposed alternatives to defraying health costs, such as flexible federal spending accounts given to every eligible American.

As the deal moves forward, here’s what its passage could mean for the Affordable Care Act tax credits — and for enrollees who take advantage of them.

Subsidies may end without any replacement

If the current legislative package is approved and Congress takes no further action on health care costs this year, the enhanced tax credits that helped many Americans pay for health insurance plans under the Affordable Care Act for four years will disappear.

On average, that would result in more than double what subsidized enrollees currently pay for premiums, according to an analysis by the health care research nonprofit KFF.

Those hardest hit will be a small number of high-income earners who will have to pay more without the additional subsidies and a large number of low-income earners who will have to pay a small additional amount, said Cynthia Cox, vice president and director of KFF’s ACA program.

Over time, as many younger, healthier people inevitably drop out of more expensive coverage, insurers are expected to increase costs for members of the covered population to account for them being older and sicker.

If more Americans are uninsured and cannot pay out of pocket for emergency health care, some of their health costs will also fall on hospitals and the government.

The shock of the Affordable Care Act’s price hikes has already hit Americans shopping for health insurance for next year since the window to choose next year’s coverage began on November 1.

Her $160 a month plan is set to increase by about $100 a month starting next year, 51-year-old hairstylist Christine Meehan, a Pennsylvania resident who relies on marketplace health insurance, told The Associated Press. Her annual deductible will also be higher.

Congress can extend the benefits, or restore them if they expire

Although Republicans leading the House and Senate have so far refused to participate in extending tax breaks as part of a deal that ends the shutdown, it is not too late for Congress to take that step if they reach one. They can even reinstate benefits after they expire.

Such a move is likely to gain widespread support among Americans, according to a recent poll. About three-quarters of US adults — including about half of Republicans — still support extending expiring tax breaks, according to a new KFF poll conducted October 27-November 2.

If lawmakers save the subsidies, federal and state markets will have to adjust the plans they made available to consumers. Insurers and outside experts say it can be done, but it could take weeks and will become more difficult over time.

Even if the subsidy is extended, it may already be too late for some potential enrollees who already have more than a week to see higher prices next year and make other plans.

“They may react and say this is too expensive for me, I can’t afford it anymore,” Cox said. “There’s no guarantee you can convince that person to come back and shop again.”

Congress may seek to find other ways to reduce health costs for Americans

If the enhanced tax breaks expire, lawmakers can still find other ways to help Americans afford health insurance – although reaching any agreement is likely to be difficult in a closely divided Congress, especially on an issue that has long been polarizing.

On Saturday, Trump called for the money saved by not providing support to be sent “directly to the people.” On his platform Truth Social, he criticized the Affordable Care Act and said Americans should be able to use savings to buy other types of care instead.

Senate Health Committee Chairman Bill Cassidy, R-Los Angeles, has offered some ideas along these lines. In a speech last week, he said eligible Americans could be sent a “pre-funded flexible federal spending account” to use for health expenses, from dental care to prescription drugs and preventive services.

On Saturday, Sen. Rick Scott, Republican of Florida, posted on X that he was working on a bill to meet Trump’s request and give money directly to Americans in funds similar to health savings accounts.

These plans are currently preliminary and far from implementation, and it is unclear how much money they could save Americans on health care.