The workers whose health care is most at stake in the government shutdown

They are restaurateurs and beauticians, landscapers and mediators, chiropractors and funeral directors. They are freelancers, contractors and gig workers. And they now find themselves stuck in the middle of the political battle that has shut down the government.

At the core of the congressional stalemate is how much people should pay for their Affordable Care Act health policies, also known as Obamacare, and how much the government should pay in federal subsidies.

Roughly half of the adults covered under Obamacare — or about 10 million — are small-business owners, their employees or the self-employed, according to KFF, a nonpartisan health policy organization, a fact often obscured by common misperceptions about who relies on the government-subsidized health insurance. As small players in American health care, they are unable to afford the same health coverage that big companies offer, and they often depend instead on Obamacare for their individual policies.

“It’s a lot of gamesmanship, and the people are like the pawns,” said Lester Johnson, who with his wife, Yolanda, owns and run Mama J’s, an established Southern cooking and soul food restaurant.

Republicans have proposed subsidy cuts that could more than double their premiums beginning in 2026, while Democrats want to maintain the expanded subsidies that have been in place since the pandemic.

The Johnsons rely on Obamacare for themselves and their 8-year-old daughter, paying about $700 a month. Lester estimates that if the subsidies are pared back, their bill would go up to more than $1,400. Many of his roughly 40 employees would see premium hikes as well.

“It’s a lot of money for people,” Johnson said — and not knowing what the price is going to be because of the stalemate in Congress adds uncertainty. “I think everybody’s feeling the anxiety.”

In the coming weeks, large increases for Obamacare are expected to be announced state by state. The prices for Idaho have been released already, and without extended subsidies, some recipients would see their monthly bills rise by hundreds of dollars. The anticipated outcry over the rising cost of coverage is why Republicans may have the most to lose politically from the shutdown.

Opponents have sometimes characterized ACA subsidies as an expensive federal giveaway, but large numbers of beneficiaries are making a living, according to research from KFF. They simply make too much to qualify for Medicaid and cannot afford the costs of individual private insurance.

A dozen workers interviewed for this story say it’s a common misperception.

“I’m quite frustrated — I’ve worked regularly since I was old enough to get a work permit,” said Nance L. Schick, 56, a New York employment attorney and workplace mediator living in Virginia who expects her business to generate about $60,000 this year. Without any Obamacare subsidy, she’d have to pay $12,000 a year for insurance, a substantial portion of her personal income. “I also have to have a place to live.”

Then, pointedly, Schick referred to the false claim recently made by some politicians that Obamacare serves migrants here illegally. “I am not an undocumented immigrant,” she said.

The KFF research offers other insights into ACA recipients. Within some occupations, more than a quarter of workers are enrolled. Those include chiropractors; musicians and singers; real estate brokers and sales agents; manicurists and pedicurists; dentists; and farmers and ranchers.

The recipients are also most concentrated in Republican congressional districts. Nearly six in 10 Obamacare enrollees live in congressional districts represented by a Republican, and the highest concentrations are in red states: Florida, Georgia, Mississippi, South Carolina, Texas and Utah.

“People have this caricature of people who get Obamacare,” said Cynthia Cox, a researcher at KFF who focuses on the Affordable Care Act. “They are often people who work, they have an income, but their jobs do not offer health insurance.”

In surveys by the National Federation of Independent Business, small-business owners have ranked the cost of health insurance as their biggest problem. Millions of them rely on health insurance subsidies from the government of one kind or another.

“Small businesses have smaller margins, less cash and less access to capital. They have struggled to provide health coverage,” said John Arensmeyer, the founder and chief executive of Small Business Majority, a group that advocates for small businesses. “For them, the ACA has been a tremendous benefit.”

Under Obamacare, entrepreneurs and their workers can choose coverage from a variety of private health insurance plans. The cost of those plans is subsidized by the federal government in amounts that vary depending on the recipient’s income.

During the COVID pandemic, the Biden administration championed increased ACA subsidies for two years, then extended those increases another two years. The expanded subsidies are set to expire in December.

If Congress does not continue with the current larger subsidies, older Obamacare enrollees, especially early retirees and the self-employed, would see some of the steepest increases in premiums. For example, an average 60-year-old couple making $85,000 is expected to see yearly premium payments rise by over $22,600 in 2026, according to KFF estimates.

Republicans, who in past years have unsuccessfully sought to repeal the ACA, have opposed an extension. They note that the subsidies were adopted as an emergency measure, not a permanent policy. If the subsidy increases were extended another 10 years, the cost to the federal government would be about $350 billion, according to the Congressional Budget Office.

“COVID-19 is long over, but vestiges of its spending spree and the progressive policies it drove still linger in Washington,” House Budget Committee Chairman Jodey Arrington (R-Texas) wrote in an op-ed that appeared last month in the Washington Examiner.

While the standoff in Congress may seem like an abstraction for many Americans, those workers relying on Obamacare are watching closely and hoping.

“It’s a money thing,” said Francis Wright, 47, a forklift operator at a Virginia paper plate factory where he has worked for 17 years. He makes $21 an hour and pays $104 a month for health care coverage, a small fraction of what it would cost without the current federal subsidy. “The politicians want to put the money in their own pocket.”

Ashleigh Tucker is managing partner of 4Corners Riversports, a shop that sells kayaks and runs a paddle school in Durango, Colorado. It employs between 15 and 40 people depending on the season, and all of them are on Obamacare, she said. Tucker was one of scores of small-business owners who wrote a letter to Congress asking that they extend the increased subsidies.

“It’s already really expensive to live here, and having a premium that doubles is just not going to be doable for lot of people,” she said. “They just won’t have insurance.”

Rachel Rozner, 39, is the owner of the Elden Street Teashop in Reston, Virginia, where five of her seven employees are on ACA plans.

“A lot of people just can’t afford their own plan,” she said. “For me, in starting this business, it was a game changer.”

Teresa Hussein, 50, is a technical writer who works on contract and makes less than $55,000 a year. With the subsidy, she pays $350 a month for an Obamacare plan.

“I have to have insurance — it’s not an option for me,” she said. “I’m a diabetic. I have to have meds or I die.”

Keven Patchett, director of the ACA marketplace in Virginia, said that the increased subsidies that began in 2021 enabled more than 40,000 workers making between $20,000 and $30,000 to get health insurance. Without the increased subsidies, he said, some of them may have to choose between paying for insurance or for rent.

“We have 400,000 Virginians who will see a meaningful increase in their rates,” Patchett said. “For some, it’s going to be sticker shock.”