By Amanda Seitz, KFF Health News

Hours into the federal government shutdown, Julio Fuentes stood steps from the U.S. Capitol to deliver an urgent message about the Hispanic voting bloc that helped the GOP sweep into power last year.

Those votes, he cautioned, are at risk if Congress doesn’t pass a law to preserve lower premiums on Affordable Care Act marketplace plans for the roughly 4.7 million people living in his home state of Florida who are enrolled in the coverage.

“Hispanic voters helped return Donald Trump to the White House,” said Fuentes, CEO of the Florida State Hispanic Chamber of Commerce, who called on Congress to reopen the government to work out a deal on the tax credits. “Republican leaders would do right by their constituents to keep coverage affordable, and they will remember that heading into the midterms.”

With less than a month to go before many Americans pick their health insurance plans for the next year, Democrats in Congress are holding up government funding to pressure Republicans into extending billions of dollars in federal tax credits that have in recent years dramatically lowered premiums and contributed to record-low rates of uninsured Americans.

Democrats see the high-stakes standoff as a chance to talk about affordable health care as millions of Americans — including those enrolled in coverage through a workplace or Medicare — brace for higher costs next year. Party leaders, hoping to win back support from some of the working-class supporters who have drifted away from them, have used the moment to remind voters of the recent cuts Republicans have approved to some health care programs.

Republicans are outwardly exuding confidence that the approach will not find traction, reminding the public that Democrats forced the shutdown. But a new KFF analysis shows that 80% of all premium tax credits benefited enrollees in states Trump won.

The shutdown coincides with open enrollment season, with insurers preparing to send notices revealing next year’s premium rates for roughly 24 million people enrolled in ACA coverage. The average enrollee is expected to pay more than double if the tax credits are left to expire. Insurers have also said they’ll have to dramatically raise the price of premiums because healthier people will opt out of coverage as it becomes more expensive, leaving a sicker pool of Americans — and less money to cover them.

“Over the next few days, what you’re going to see is more than 20 million Americans experience dramatically increased health care premiums, copays, and deductibles because of the Republican unwillingness to extend the Affordable Care Act tax credits,” House Minority Leader Hakeem Jeffries said Oct. 2 on the steps of the Capitol.

House Minority Leader Hakeem Jeffries (L), D-NY, and Senate Minority Leader Chuck Schumer (R), D-NY, speak to reporters outside the White House in Washington, DC, on September 29, 2025. (Photo by JIM WATSON/AFP via Getty Images)

Open enrollment in most states begins on Nov. 1. Some insurers and exchanges have delayed sending notices detailing premium rates for next year, because they are waiting to see what unfolds in Washington. For example, Covered California, the state’s insurance marketplace, is planning to mail out notices to more than a million enrollees later than usual this year, on Oct. 15.

From her home in Richmond, Virginia, 31-year-old Natalie Tyer is anxiously awaiting the arrival of her notice. She checks the state’s marketplace website daily to see whether new rates for her insurance plan have been posted.

Tyer has been relying on marketplace coverage for over a year now while she works part-time for a small video production company and pursues a master’s degree to become a school counselor. The tax credits help cover $255 of her monthly premium, bringing it down to $53. Since she’s generally healthy, if the credits expire and her premiums go up significantly, she might drop coverage altogether.

“I very well might have to go without health insurance and may have to rely on hope,” Tyer said.

Democrats’ push to center the shutdown on health care affordability, though, runs up against many uncomfortable realities of the federal government’s closure, which will leave millions of federal workers without paychecks, hamper some functions of public health agencies, and threaten food assistance payments for low-income mothers, among other effects.

The ACA, meanwhile, has been a political flash point since 2010, when Republicans fought against the passage of the landmark health care legislation. A wave of Republican congressional victories soon followed that fight, spurring a government shutdown in 2013, when the GOP tried to gut the program. Party leaders again tried to repeal it in 2017 to follow through on a Trump campaign promise.

The latest clash — over the billions of dollars in tax credits that Democrats issued during the COVID-19 pandemic to boost enrollment in the ACA — has been simmering for months. Democrats, who wrote the original legislation introducing and then extending them, set the enhanced tax credits to expire at the end of this year. Even some Republicans began warning this summer that letting those tax credits lapse could be detrimental, with Republican pollsters Tony Fabrizio and Bob Ward issuing a memo cautioning that an extension of the credits could make a difference in next year’s midterm election.

Extending the ACA tax credits, which have reduced monthly premiums to as little as $0 for poorer enrollees and capped the amount middle-income Americans pay to just 8.5% of their income, also would be a popular move.

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More than three-quarters of Americans want those tax credits to continue, according to a new KFF poll conducted before the shutdown. About 3 in 4 people said they will blame Trump or the GOP if they end. KFF is a health information nonprofit that includes KFF Health News.

Although they’ve declined to address the tax credits so far this year, Republican Party leaders have signaled they are willing to extend the ACA tax credits, but with new restrictions on who qualifies for them. GOP leadership has also said they want to hash out the policy details over several weeks, not under the gun of a shutdown.

On Oct. 6, House Speaker Mike Johnson accused Democrats of manufacturing a political issue to shut down the government and urged them to pass the continuing resolution just to “keep the lights on.”

“They decided that they would pick a fight on health care,” Johnson said, adding that he believes the tax credits are “a Dec. 31 issue,” referring to when the credits are set to expire.

Since open enrollment begins next month, insurers will need to start posting premium prices for customers to window-shop in the coming days. Democrats have argued that waiting months to work out a deal, which could change those prices, might spur widespread confusion.

While more Americans appear to be faulting Trump and Republicans for the shutdown, only a quarter of people are convinced that the Democrats’ proposal to extend the ACA tax credits is worth closing the government over, according to a CBS News poll over the weekend.

Health care is typically a winning message for Democrats, who have struggled to coalesce around issues that appeal to the working class in recent years, said William Pierce, a health policy consultant who served under President George W. Bush.

“It’s all about health care. They need to make this all about health care,” Pierce said, describing it as a weak spot for Republicans. “They need to just keep talking about it, constantly.”

Republicans in the White House and Congress have countered with factually dubious claims that Democrats are seeking to expand free health care for immigrants who do not have legal status in the U.S.

In fact, such immigrants are not eligible for enrollment in the marketplace, and Democrats have not proposed opening ACA coverage to them in their proposal.

Back in Richmond, as Tyer worries about her coverage for next year, she’s bothered to see the debate focus on immigrants. Some of her classmates and colleagues are worried, too.

“The reality is, what’s happening with these tax credits is that normal people — people who want to work in the public sector, who want to educate kids — we are also going to lose health care,” Tyer said.

KFF Health News senior correspondent Bernard J. Wolfson contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

The Woodbury girls soccer is hitting its stride at the right time. The Royals won 10 of their final 11 regular season games.

Senior goalie Sam Mattes and junior forward Clara Fedunok spearheaded the late-season surge. Fedunok orchestrates the offense, while Mattes directs the defense en route to an 11-2-1 campaign.

Mattes said the Royals set a goal in the buildup to the season of making the state tournament. That journey kicks into overdrive Wednesday, when second-seeded Woodbury hosts seventh-seeded Tartan in the Class 3A, Section 4 quarterfinals.

“This team definitely has that ability. For us, it’s staying focused,” Mattes said. “We make it a big thing about getting our school work done, separating school and soccer when we need to. So, having that driving force, focusing on one game at a time.”

Fedunok, a Marquette commit, has exhibited her technical ability and leadership throughout the 2025 season. Woodbury girls soccer coach Pat Malicki said her relentless work ethic and skill on the ball are integral to the Royals’ attack.

Undated courtesy photo of Woodbury junior forward Clara Fedunok, who fires a shot for the Royals during the 2025 season. (Courtesy of Rich Peterson)

“She’s gonna beat players one v. one, and she’ll get to the goal and she can finish with both left foot and right foot,” Malicki said. “When she gets marked, she’s able to get (to the) endline and get service across. She’s basically the quarterback of our attack.”

Fedunok said her coach’s confidence in her is an added motivator, which pushes her to perform. She leads Woodbury with seven goals and has tallied five assists on the season.

Fedunok said her gritty mentality and motor have led to her offensive production.

“I’m sort of an aggressive player, I like getting the ball,” Fedunok said. “I like winning the ball back, and I think that my speed definitely helps.”

The Royals have also sported one of the best defenses in the state. Woodbury has kept nine clean sheets in 14 games played.

Mattes has made 61 saves this season while only allowing nine goals, posting a 0.69 goals against average.

Malicki said Mattes is a student of the game, which allows her to see opponent’s buildup and instruct her back line on how to align.

“Over the last couple of years, her communication has improved so much. So she’s organizing our back line,” Malicki said. “So, right there is what’s helping her as it’s preventing a lot of shots and finishes.”

Mattes said her communication on the pitch extends beyond her defense, even involving midfielders and forwards to keep the entire team in sync.

Woodbury has outscored its opponents 36-9 this season. Mattes said limiting chances requires everyone to understand their role and assist teammates through communication. Mattes said a large part of the credit for her team’s strong defensive record is thanks to her back line and the chemistry the team has developed.

“I scan [the field] to make sure they know what they’re doing because if we have someone who isn’t as familiar with the position, the defenders and I are good at helping them out with that,” Mattes said. “But it’s really reliability and trust.”

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October’s supermoon — a phenomenon when the moon is closest to Earth, making it appear larger and brighter — is the first of three this year. The subtle difference can be observed without special equipment if skies are clear.

This is a photo gallery curated by AP photo editors:

The Harvest Supermoon rises, in London, Monday, Oct. 6, 2025. (AP Photo/Kin Cheung)
The Harvest Supermoon rises behind spires of the Duomo gothic cathedral, in Milan, Monday, Oct. 6, 2025. (AP Photo/Luca Bruno)
A Southwest Airlines plane appears between the Harvest Supermoon and a statue of Jesus Christ atop Iglesia Luterana Santa Maria de Guadalupe as it takes off from Dallas Love Field Airport, Monday, Oct. 6, 2025, in Irving, Texas. (AP Photo/Julio Cortez)
The Harvest Supermoon rises behind Tower Bridge, Monday, Oct. 6, 2025, in London. (AP Photo/Julia Demaree Nikhinson)
The Harvest Supermoon rises as a red double-decker bus drives past on Tower Bridge, Monday, Oct. 6, 2025, in London. (AP Photo/Julia Demaree Nikhinson)
The Harvest Supermoon rises behind the cross of ‘Metamorphosis Sotiros’ Christian Orthodox Church at Anthoupolis outskirts of capital Nicosia, Cyprus, on Monday, Oct, 6, 2025. (AP Photo/Petros Karadjias)
The full Harvest Moon rises behind a cloud in the sky in Hadera, Israel, Monday, Oct. 6, 2025. (AP Photo/Ariel Schalit)
A person photographs the Harvest Supermoon as it rises behind Tower Bridge, Monday, Oct. 6, 2025, in London. (AP Photo/Julia Demaree Nikhinson)
The Harvest Supermoon descends behind the Bay Bridge as seen from Alameda, Calif., Tuesday, Oct. 7, 2025. (AP Photo/Godofredo A. Vásquez)
The Harvest Supermoon sets in the clouds behind the city landmark, a weather vane in the form of an angel fixed atop a spire of the Saints Peter and Paul Cathedral in St. Petersburg, Russia, early Tuesday, Oct. 7, 2025. (AP Photo/Dmitri Lovetsky)
The Harvest Supermoon rises over the Thien Tau Temple in Chinatown Los Angeles Monday, Oct. 6, 2025. (AP Photo/Damian Dovarganes)
The Harvest Moon rises over Los Angeles, Monday, Oct. 6, 2025. (AP Photo/Jae C. Hong)

Paula Andalo, KFF Health News

About 1,500 federally funded health centers that serve millions of low-income people face significant financial challenges, their leaders say, as the government shutdown compounds other cuts to their revenue.

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Some of these community health centers may have to cut medical and administrative staff or reduce services. Some could eventually close. The result, their advocates warn, may be added pressure on already crowded hospital emergency rooms.

“This is the worst time in all the years I have been working in health care,” said Jim Mangia, president and CEO of St. John’s Community Health, a network of 28 clinics that serves more than 144,000 patients in Los Angeles, Riverside, and San Bernardino counties in California. “We are facing federal cuts and extreme state cuts that will impact services.”

St. John’s and other federally qualified health centers offer primary care and a wide range of other services free of charge or on a sliding fee scale. Nationwide, they see nearly 34 million patients in the country’s most underserved areas.

The federal funds come through two primary routes, both of which face challenges: grants paid in part through the federal Community Health Center Fund and reimbursements for patients’ care through programs like Medicaid, which provides health insurance for low-income people and people with disabilities. Medicaid is jointly funded by states and the federal government.

Congress has approved the grant money in dribs and drabs recently. In March, lawmakers extended the funds until Sept. 30. That money expired after the Republican-controlled Congress did not pass a funding law, leading to a government shutdown.

Advocates say the health centers need long-term funding to help them plan with more certainty, ideally through a multiyear fund.

The centers received $4.4 billion in grants in early 2024. The National Association of Community Health Centers is advocating for at least $5.8 billion in grants annually for two years to keep the centers fully functional.

The health center safety net faces “multiple layers of challenges,” said Vacheria Keys, vice president of policy and regulatory affairs for the association.

The new spending law that Republicans call the “One Big Beautiful Bill Act” will significantly cut Medicaid, raising the second set of threats for health centers.

Medicaid accounted for 43% of the $46.7 billion in health center revenue in 2023.

Advocates said lower Medicaid payments will exacerbate a gap between funding and operational costs.

Funding for workforce programs also is needed to support the delivery of health care services as centers struggle to hire and retain workers, said Feygele Jacobs, director of the Geiger Gibson Program in Community Health at George Washington University.

The first clinics of this type opened in places such as Massachusetts in the 1960s. Congress typically has funded them with bipartisan support, with minor fluctuations.

The struggle this year began when the Trump administration froze domestic aid through a January memo, which prevented some centers from receiving already approved grant money. As a consequence, some health centers in states such as Virginia closed or merged operations.

The upcoming cuts also are set to arrive at a time when patients will face new demands and challenges. The Medicaid changes in President Donald Trump’s tax-and-spending law include requirements for Medicaid enrollees to report their work or other service hours to keep their benefits.

Meanwhile, more generous tax credits the Biden administration and Congress provided consumers to help pay for Affordable Care Act health insurance are set to expire at the end of the year. Some consumers’ costs will spike if Congress doesn’t renew them.

One reason the government shut down is that Democrats want to extend the tax credits, which protect consumers from higher insurance costs. The Republican funding bill did not include an extension; Republican congressional leaders say the issue should be addressed separately.

Consumers “will need more support than ever,” said Jacobs, noting that Medicaid cuts and the expiration of the higher tax credits will both “potentially throw people out of coverage.”

Ninety percent of the centers’ patients have incomes that are twice the federal poverty level or less, and 40% are Hispanic.

“We are also receiving 300 calls per day from patients concerned about their coverage,” said Mangia, from St. John’s.

Republicans are not directly targeting the centers, although they supported the Medicaid cuts that will affect the clinics’ finances. Many Republicans say Medicaid spending has ballooned and that reducing the program’s growth will make it more sustainable.

State and Local Support

While advocating for longer-term federal funding, the centers also are looking to their community and local governments for backing.

Some states already took action while finalizing their annual budgets. Connecticut, Minnesota, Illinois, and Massachusetts allocated money for centers. Maryland, Oregon, and Wisconsin also provided support for the health centers.

The question is how long the money will last.

While some states boosted their support of the centers, others are going in the opposite direction. Anticipating the impact of Medicaid cuts, states such as California made their own cuts to the program.

California Gov. Gavin Newsom’s office, the federal Department of Health and Human Services, and the federal Health Resources and Services Administration did not respond to requests for comment.

In Los Angeles, Mangia said, one potential solution is to work with partners at the county level, noting that L.A. County has about 10 million residents.

“We can tax ourselves to increase funding for health care services,” he said.

Health center leaders are building a coalition that “hopefully” will include the main stakeholders in the county’s health care system — community health centers, clinics, hospitals, doctors, health plans, unions — to begin the process to fill out a ballot petition, Mangia said. The goal: Put the question about taxes for health centers on the ballot and let voters decide.

“We are learning that the federal government and the state government are not reliable when it comes to continuing to fund health care,” Mangia said.

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.