House Speaker Mike Johnson at Columbia University in New York City on April 24, 2024

The standoff over the federal shutdown has exposed deep fractures within the GOP, particularly around health care — a longstanding vulnerability for Republicans.

The New York Times highlighted in a report Sunday that while Democrats insist they will not support a spending deal without extending the expiring tax credits under the Affordable Care Act (ACA) that safeguard coverage for millions, Republicans are split between ideology and electoral reality.

On one end, hard-line conservatives still press to eliminate the ACA outright; on the other, pragmatists recognize that wiping it out without a credible replacement could inflict “a political disaster” on their party, per the report.

The shutdown has forced the GOP into a public tug-of-war over what to do with a law they largely oppose but cannot realistically undo without major risk.

House Speaker Mike Johnson (R-La.) insisted the dispute is not about health care, calling Democrats’ insistence on subsidies a “red herring” that distracts from the funding fight.

At the same time, top Republicans such as House Majority Leader Steve Scalise (R-La.) pledged to vote against extending the credits, arguing they would “bail out insurance companies,” even as many recipients live in GOP-held districts.

At least 14 House Republicans and several senators signaled they would support a renewal of the credits through 2027, recognizing what some advisers called “a potential political catastrophe for the G.O.P.” if coverage were lost.

The report noted that the broader dynamic reveals why the party remains stuck. Even though Republicans have long pledged to “repeal and replace” the ACA, they have repeatedly failed to articulate what “replace” means in practice. The 2017 Senate health care bill collapsed amid conservative-moderate splits, leaving GOP leaders without an alternative mapped out.

According to the report, Democrats "have forced the G.O.P. to wrestle publicly with its divisions about what to do with the health care law, which most Republicans revile but many recognize would be impossible to unravel without bringing political disaster to their party.”