Dr. C.D. Casscells is the director of the Center for Health Policy at the Caesar Rodney Institute.
As the federal shutdown continues, Delaware residents may wonder whether their health insurance premiums will rise. The short answer is no for most policyholders. The current debate in Washington concerns temporary Affordable Care Act (aka “Obamacare”) marketplace subsidies that affect only a small share of Delaware’s insured population.
What the law says
Under the Antideficiency Act, federal agencies must pause most operations when Congress fails to pass a budget, according to the U.S. Government Accountability Office. The GAO notes that this is a legal requirement, not chaos.
In Congress, a simple majority in the House of Representatives and 60 votes in the Senate are generally needed to pass funding measures.
The current dispute involves ACA marketplace subsidies, not Medicaid. These tax credits, broadened during the pandemic to include some households above 400% of the federal poverty level when premiums exceed 8.5% of income, are scheduled to expire at the end of 2025, unless extended. According to KFF, these subsidies are key to keeping premiums affordable for many enrollees.
Meanwhile, hospitals remain open. The Emergency Medical Treatment & Labor Act requires emergency departments to treat and stabilize patients regardless of insurance status or a shutdown.
What’s driving the shutdown?
Supporters of extending the subsidies argue that they are necessary to prevent higher costs for ACA enrollees. Others contend that the subsidies were always meant to be temporary and should end as scheduled.
For the majority of Americans:
These programs represent the overwhelming majority of insured Americans.
Health insurance is not health care
Health insurance is a financial product — a way to share the cost of medical care through premiums and deductibles. Health care is the delivery of those services: doctors, hospitals and pharmacies providing actual treatment.
You can have insurance yet still face barriers to care, such as high out-of-pocket costs or limited provider networks. Hospitals must still provide emergency treatment under federal law, regardless of funding delays.
The Affordable Care Act reshaped the insurance market but did not directly change how medical care is delivered or priced.
Since its creation, the ACA marketplace has struggled to remain stable without federal subsidies. When subsidies have been reduced or eligibility narrowed, enrollment has consistently declined — evidence that many consumers find full-price premiums unaffordable.
Impact on rates
For most Americans — particularly those covered by Medicare, Medicaid or employer-based insurance — premiums will not change as a result of the shutdown or the expiration of temporary subsidies.
According to a Delaware Department of Insurance announcement in August, the state’s ACA marketplace plans could see rate increases averaging 25%-35% for 2026 if the enhanced subsidies expire. That would primarily affect higher-income households that benefited from the temporary expansion.
If the subsidies continue, they will require additional taxpayer funding — costs ultimately absorbed through higher federal and state spending.
For most Delawareans, including working families, retirees and low-income individuals, insurance costs will remain stable.
What consumers can do
The bottom line
The government shutdown is a legal budget procedure, not a crisis that will rewrite anyone’s health plan. For most Delawareans — and most Americans — health insurance rates will remain steady.
While a small portion of Affordable Care Act enrollees may see higher premiums if temporary subsidies expire, the majority will experience no change. If temporary subsidies expire as scheduled, the marketplace may gradually rebalance, as insurers adjust to sustainable pricing and competition.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
