KFF Health Tracking Poll: Public Weighs in on Health Care Debate and Government Shutdown 

Key Takeaways

• On October 1^st the U.S. federal government shut down after Congress failed to pass a stopgap spending bill to keep it funded. Now in its sixth week, the shutdown marks the longest lapse in federal funding in U.S. history. Congress remains at a standstill over whether to extend the Affordable Care Act’s enhanced premium tax credits (ePTCs). About three quarters of the public continue to say Congress should extend the expiring tax credits, including more than nine in ten (94%) Democrats, three in four (76%) independents, and half of Republicans. As the debate continues, this poll shows that partisan loyalties among the public are deepening, with Republicans split over whether they want Congress to extend the tax credits for people who purchase their own coverage on the ACA marketplaces or allow them to expire.
• Democrats largely support what congressional Democrats have been doing throughout this debate, while independents are split. A large majority of Democrats (81%) say Democrats in Congress should “refuse to approve a budget unless it includes extending these tax credits, even if it means the government remains shut down.” Independents are divided, while about eight in ten (84%) Republicans say Congressional Democrats should approve a budget to quickly end the shutdown.
• If the enhanced tax credits are not extended, both political parties could face backlash from their bases. Among those who want to see Congress extend the tax credits, nearly four in ten say President Trump (28% of all adults) deserves most of the blame, and a similar share says they would blame Republicans in Congress (28% of all adults). Fewer, about one in four (17% of all adults), say Democrats in Congress deserve the most blame. Majorities of Democrats and independents say President Trump or Republicans in Congress would deserve the most blame, while a majority of MAGA Republicans say Democrats in Congress would deserve the most blame.
• The Democratic Party maintains an edge over the Republican Party when it comes to voter trust of handling the future of the ACA, and a narrower edge when it comes to high cost of health insurance. At least one in five voters say they do not trust either party to address these issues. While majorities of Democratic and Republican voters say they trust their own party on these issues, independents are more likely to trust the Democratic Party over the Republican Party on the ACA (38% vs. 18%), though many say they don’t trust either party. Democratic and independent voters are also much more likely than Republican voters to say rising health costs would impact their willingness to vote and their candidate choice. Nearly six in ten Democratic voters and half of independent voters say an annual health cost increase of $1,000 – the average expected increase for marketplace enrollees if the ACA enhanced premium tax credits expire – would have a “major impact” on both their decision to turnout to vote and which candidate they would support, compared to about three in ten Republican voters.  

Majorities of the Public Continue to Support Extending ACA Tax Credits; Most Democrats Want Budget Deal to Include Extension

As part of the ongoing budget negotiations, Democratic leaders are pushing to extend the enhanced premium tax credits, which help some people afford their health insurance through marketplaces created by the Affordable Care Act (ACA). These tax credits are currently set to expire at the end of the year. Republican lawmakers, on the other hand, say they will take up the ACA tax credits after the government is reopened.

Conducted as people began reviewing ACA plan options for this year’s open enrollment, this poll shows that extending these tax credits beyond 2025 continues to be popular among the public. About three quarters (74%) of U.S. adults overall say Congress should extend the enhanced tax credits for people who purchase their own insurance through ACA marketplaces, about three times the share who say Congress should let these credits expire. Three quarters (76%) of adults who purchase their own health insurance, most of whom do so through ACA marketplaces, support the extension of these tax credits, while one in four (23%) say they should expire.

At least half of adults across partisans continue to support the extension of these tax credits. This includes more than nine in ten (94%) Democrats, three quarters (76%) of independents, and half of Republicans. However, Republican support for Congress extending the tax credits has dropped nine percentage points in the past month as the enhanced premium tax credits have become a talking point around the budget negotiations and a major sticking point for Democratic lawmakers. In addition, supporters of the “Make America Great Again” (MAGA) movement are now 13 percentage points less likely to say these tax credits should be extended, from about six in ten (57%) last month, to fewer than half (44%) now.  

Now in its sixth week, the government shutdown has resulted in missed paychecks for some federal employees and delays in full SNAP benefits, adding pressure on Congress to reach an agreement. Overall, the public is split over what they think Congressional Democrats should do, with half (50%) saying they should “approve a budget that does not include extending these tax credits in order to quickly end the shutdown, even if it means the cost of health insurance will increase for some people,” while a similar share (48%) say Congressional Democrats should “refuse to approve a budget unless it includes extending these tax credits, even if it means the government remains shut down.”

A large majority of Democrats (81%) support Congressional Democrats holding out for a deal that includes extending the ACA’s enhanced premium tax credits, even if it prolongs a government shutdown. Independents are split, with about half (51%) saying Democratic leaders should refuse to approve a budget without the tax credit extensions and half (47%) saying they should approve a budget to quickly end the shutdown. More than eight in ten (84%) Republicans say Democratic lawmakers should approve a budget to end the shutdown.

More than half (55%) of those who purchase their own health insurance say Democrats should refuse to approve a budget that does not include an extension for ACA subsidies, while 45% say Democrats should approve the budget without the subsidies to quickly end the shutdown. Notably, past KFF polls have shown that nearly half of adults enrolled in ACA marketplace plans identify as Republican or lean Republican.

If Congress does not pass an extension for the enhanced tax credits, those who want to see the credits extended are most likely to blame Republican leaders, including President Trump. Nearly four in ten of those who support extending the tax credits say that if they are not extended Republicans in Congress deserve the most blame (38%, or 28% of all adults) and a similar share (37%, or 28% of all adults) say President Trump deserves most of the blame. About one in four (23% or 17% of total adults) say Democrats in Congress deserve the most blame. Notably, the group that supports extending the tax credits is made up of larger shares of Democrats and Democratic-leaning independents.

Among the half of Republicans who want to see the tax credits extended, seven in ten say they would blame Democrats in Congress if the tax credits are allowed to expire, rising to eight in ten MAGA-supporters.

Despite the ongoing legislative debate over the government shutdown, awareness of the lapsing enhanced premium tax credits remains limited, even among the group most directly impacted by the loss of tax credits. Overall, more than half of adults say they have heard or read “a little” (28%) or “nothing at all” (29%) about the issue, while 44% have heard or read “a lot” (13%) or “some” (30%). Among those who buy their own insurance, half say they have heard at least “some,” compared to four in ten last month.

Some Republican lawmakers have claimed that Democratic efforts to extend the ACA’s enhanced premium tax credits would allow undocumented immigrants to receive federally subsidized health insurance. This KFF poll gauged the public’s understanding of this claim over who is eligible for ACA coverage. About half (47%) of U.S. adults correctly say that undocumented immigrants are not eligible to buy health coverage on ACA marketplaces. There is some confusion, however, as about one in seven (14%) incorrectly say undocumented immigrants are eligible and nearly four in ten (39%) say they are not sure.

Although this claim has been made by some Republican lawmakers and conservative media outlets, there are no partisan differences in awareness of this aspect of ACA eligibility. At least half of Republicans (57%) and Democrats (52%) say undocumented immigrants are not eligible for this, while at least three in ten across partisans say they are not sure. A larger share of independents (44%) say they are not sure whether undocumented immigrants are eligible to buy coverage on the ACA marketplaces.

Health Costs Could Influence Voters in 2026, and Democratic Party Holds Edge on Trust to Address ACA

There is some indication that these budget negotiations could influence how voters think about health care and their decisions at the ballot box in coming years. Consistent with previous polling, the Democratic Party continues to hold an advantage over the Republican Party among voters on which party they trust to do a better job addressing the future of the 2010 Affordable Care Act, or ACA. About four in ten voters (43%) say they trust the Democratic Party to do a better job addressing the future of the ACA compared to one-third (32%) of voters who say they trust the Republican Party. Democrats also have a small advantage on which party voters trust to address the high cost of health insurance (39% v. 33%), though a quarter of voters say they trust neither party on this issue.

On both health care issues, Democratic and Republican voters largely trust their own party. While the Democratic Party has a strong advantage over the Republican Party among independent voters on who they trust to do a better job handling the future of the ACA (38% v. 18%, respectively), independents are more split on which party they trust to address the high cost of health insurance.  More than one-third of independent voters say they do not trust either party to do a better job handling the ACA’s future (36%) or addressing the high cost of health coverage (41%).

As leaders in both political parties blame each other for the extended government shutdown, Democratic and Republican campaign groups have started running ads in competitive congressional districts, in hopes that the situation will boost their party’s standing with voters.

Yet, the possibility of increasing health care costs resonates as a stronger motivator for Democratic voters and independent voters, rather than Republican voters. When asked how a $1,000 increase in their health care costs – the average expected increase for marketplace enrollees if the ACA’s enhanced premium tax credits expire – would affect their 2026 vote, nearly six in ten Democratic voters and more than half of independent voters say it would have a “major impact” on both their decision to vote (59% and 54%) and which candidate they support (56% and 52%). About three in ten Republican voters say such an increase would have a “major impact” on either their decision to turn out or who they support. Although the expiring enhanced premium tax credits directly affect only those who purchase their own coverage on the ACA marketplaces, this suggests that rising health care costs resonate more as a voting issue among Democrats and independents than Republicans.

This KFF Health Tracking Poll was designed and analyzed by public opinion researchers at KFF. The survey was conducted October 27-November 2, 2025, online and by telephone among a nationally representative sample of 1,350 U.S. adults in English (n=1,274) and in Spanish (n=76). The sample includes 1,031 adults (n=63 in Spanish) reached through the SSRS Opinion Panel either online (n=1,007) or over the phone (n=24). The SSRS Opinion Panel is a nationally representative probability-based panel where panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS); (b) from a dual-frame random digit dial (RDD) sample provided by MSG. For the online panel component, invitations were sent to panel members by email followed by up to three reminder emails. 

Another 319 (n=13 in Spanish) adults were reached through random digit dial telephone sample of prepaid cell phone numbers obtained through MSG. Phone numbers used for the prepaid cell phone component were randomly generated from a cell phone sampling frame with disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity groups within each frame. Among this prepaid cell phone component, 143 were interviewed by phone and 176 were invited to the web survey via short message service (SMS). 

Respondents in the prepaid cell phone sample who were interviewed by phone received a $15 incentive via a check received by mail. Respondents in the prepaid cell phone sample reached via SMS received a $10 electronic gift card incentive. SSRS Opinion Panel respondents received a $5 electronic gift card incentive (some harder-to-reach groups received a $10 electronic gift card). In order to ensure data quality, cases were removed if they failed two or more quality checks: (1) attention check questions in the online version of the questionnaire, (2) had over 30% item non-response, or (3) had a length less than one quarter of the mean length by mode. Based on this criterion, one case was removed.

The combined cell phone and panel samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2024 Current Population Survey (CPS), September 2023 Volunteering and Civic Life Supplement data from the CPS, and the 2025 KFF Benchmarking Survey with ABS and prepaid cell phone samples. The demographic variables included in weighting for the general population sample are gender, age, education, race/ethnicity, region, civic engagement, frequency of internet use and political party identification. The weights account for differences in the probability of selection for each sample type (prepaid cell phone and panel). This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure.

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available on request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.