The looming expiration of enhanced Affordable Care Act (ACA) premium subsidies is at the center of the ongoing government shutdown, with Republicans now pushing to reopen and negotiate a potential extension afterward.
Mehmet Oz, M.D., administrator of the Centers for Medicare & Medicaid Services (CMS), echoed that sentiment in an appearance at the Aspen Institute on Monday afternoon, calling the government shutdown a "public health emergency."
He said there are levers the CMS could use to ease some of the sting of what will most certainly be rising costs for exchange enrollees, but, with the government shuttered, many of the most expert workers at the agency are unavailable to build out the strategy.
"The people who aren't there are the ones that we would crutch on to be able to figure out the best path forward," he said. "And even if you want to do it now, you don't want to make a decision of this importance in the middle of a shutdown when folks aren't at work and there's a lot of vitriol going back and forth."
Monday, House Speaker Mike Johnson, R-La., said that if a resolution is passed to keep the government funded and restart operations quickly, parties on both sides of the aisle would have plenty of time to determine what's next for the subsidies before they expire at the end of the year.
“We have effectively three months to negotiate," Johnson said in an interview with MSNBC. "In the White House and in the halls of Congress, that’s like an eternity."
However, open enrollment on HealthCare.gov begins Nov. 1, and many individuals will see for the first time just how much their premiums have risen as a result of the likely expiry of the tax credits. An analysis from KFF found that the median increase requested by health plans for 2026 was 18%, 11 percentage points above requests for the 2025 plan year. Democrats, arguing for an extension before any agreement to reopen the government, have also pointed to a Congressional Budget Office estimate that delaying any action would limit premium reductions in 2026.
Oz said those premium rates from the health plans are currently locked in, but the CMS can assist in adjusting what the enrollees ultimately pays, with tax credits one of the levers available to do so.
"Obviously it would be nice to do that before the end of this calendar year, because you start having to pay those at the beginning of next year," he said.
A recent survey from KFF found that extending the subsidies is broadly popular, including among Republicans. Overall, 78% of voters support an extension of the tax credits.
Oz also reiterated the CMS' focus on fraudulent sign-ups and broker misbehavior on the exchanges. He noted that half of enrollees in ACA plans filed no medical claims last year, a statistic at odds with people's tendency to use insurance if they pay for it.
He said there are many people who do not realize they're enrolled in plans on the exchanges at all, or they're not aware of the level of coverage they have. This is backed by data from the Paragon Health Institute, a right-wing think tank, which estimate as many as 5 million people may have been improperly enrolled on the exchanges in 2024.
The concerns around improper enrollments fall under the Trump administrations broader vendetta against fraud, waste and abuse across all sectors of the government. The CMS made key changes to open enrollment this year that seek to address the purported improper sign-ups.
He acknowledged that those changes, which could lead to fewer people enrolled overall, are playing a role, too, in driving up premiums.
"I do think that there are criminal elements," Oz said. "There are Department of Justice cases that have been won against brokers who have gamed the system, especially if you're looking at some of the ways policies were issued."