Your Money, Their Fight: How Congress Uses Healthcare Funds for Everything Else

By Alexander Fernandez

Federal healthcare funding begins and ends with the American taxpayer. In 2024, individuals and employers contributed about $1.7 trillion to Medicare and Medicaid — roughly $848 billion for Medicare and $890 billion for Medicaid — according to federal budget data. Together, these programs account for more than one quarter of total federal spending, and nearly one in three Americans receives coverage through them. Each year, Medicare collects slightly more in revenue than it pays out, creating a surplus of about $18 billion. That surplus is held in the U.S. Treasury and invested in government securities that can be used for other federal obligations. Medicaid funds are drawn from general revenues and may also be redirected within the broader budget process. Analysts say that if funds collected for these programs were reserved solely for their intended purpose, both could remain more stable and sustainable indefinitely.

The government shutdown has now lasted for more than a month, nearing the 35-day record set in 2018–2019, and could become the longest in U.S. history if it continues. Its main cause stems from disagreements of national funding which expired Sept. 30 after Congress failed to agree on how to manage rising healthcare costs within the broader federal budget. A continuing resolution (CR) was introduced to extend funding until Nov. 12, but it failed to pass, leading to a lapse in appropriations and the subsequent shutdown.

This chart shows how many total days the federal government has been shut down under each U.S. president since 1976, along with the dates those shutdowns occurred. It highlights when funding lapses happened and how long they lasted, offering a quick look at which administrations faced the longest or most frequent shutdowns.

The clash over healthcare funding centers particularly on how much the government should spend to support programs like Medicaid and the Affordable Care Act (ACA). Lawmakers remain divided over whether to continue enhanced premium subsidies under the ACA and how to manage long-term Medicaid costs.

The Centers for Medicare and Medicaid Services oversee two of the nation’s largest healthcare programs. Medicare provides health coverage for people aged 65 and older and for some younger individuals with disabilities. Medicaid offers medical assistance to low-income families and individuals, funded jointly by federal and state governments. Most federal spending in these programs goes toward hospital care, prescription drugs, physician services, nursing facilities, and state-administered health coverage for children, seniors, and people with disabilities.

Medicaid is the nation’s largest public health program, providing coverage to about 70 million to 75 million people nationwide as of mid-2025, according to federal data. Enrollment peaked at nearly 93 million during the pandemic, when states paused eligibility reviews, but began to decline after the continuous coverage rule expired on March 31, 2023. The largest numbers of participants are in California, New York, Texas and Florida, each serving more than 4 million people. Most recipients are children, low-income adults and pregnant women, while seniors and people with disabilities make up a smaller share of enrollees but account for a higher portion of overall costs.

Since its creation on July 30, 1965, Medicaid has received an estimated $14 trillion in combined federal and state funding, according to data from the Centers for Medicare and

Medicaid Services. Medicaid covers more than 72 million low-income Americans, costs about $890 billion each year, with the federal government paying roughly 69 % and states covering 31 %, or about $614 billion and $276 billion, respectively. To put that scale in perspective, Medicaid’s annual cost exceeds the combined budgets of the Departments of Defense, Education and Homeland Security. The funds gathered since its inception could theoretically finance free medical coverage for every U.S. resident for roughly four to five years, based on current national health expenditure levels. However, experts such as health economists at the Kaiser Family Foundation and the Congressional Budget Office note that rising medical costs, inflation and an aging population make universal free care financially unrealistic. The program’s scale reflects both its central role in the nation’s health system and the ongoing debate in Congress over how much the country can afford to spend on health care.

Democrats have pushed to extend subsidies and protect Medicaid expansion, while some Republicans argue for stricter limits on federal spending. On Oct. 16, 2025, the Senate voted 51–45 on the Continuing Appropriations Act, 2026, a short-term measure intended to end the shutdown and restore federal operations. Although the bill received a simple majority, it fell short of the 60 votes required to advance, marking the tenth failed attempt to pass a funding resolution since the government closed on Oct. 1.

While many Americans view the shutdown as a dispute over healthcare funding, congressional leaders have framed it differently. House Speaker Mike Johnson said the stalemate stems from the Senate’s refusal to advance short-term funding bills. He argued that Republicans have voted more than a dozen times to reopen the government but cannot do so without Democratic support, since 60 votes are required in the Senate. Johnson said Democrats have voted 12 times to keep the government closed, tying their cooperation to measures that include healthcare and foreign aid spending.

“They’re the ones voting repeatedly to shut down the government,” Johnson said. “We have no ability to do this on our own. It’s a simple math problem. You need 60 votes in the Senate. We only have 53 Republicans. We need Democrats to help [re-open the government],” Johnson said on Monday Oct. 27.

Johnson also said Democratic leaders are demanding what he described as costly provisions, including $200 billion in health benefits for noncitizens and cuts to rural hospitals, which he argued would harm working Americans. He said those conditions make compromise difficult, framing the shutdown as a broader issue of fiscal restraint rather than a fight solely over healthcare.

Democratic leaders have rebutted, saying Republicans are using the shutdown to advance broader spending cuts unrelated to healthcare. Senate Majority Leader Chuck Schumer (D-N.Y.) said talks have stalled domestic programs and foreign aid rescissions that the Democrats view as harmful to working families and U.S. interests abroad. In an interview with Punchbowl News, Schumer remarked, “Every day gets better for us,” referring to his belief that as the shutdown continues, public sentiment and political momentum would shift in favor of Democrats. He argued that the stalemate reflects partisan disagreements over defense spending, budget caps and overall fiscal priorities, not solely healthcare policy.

The government shutdown has become more than a political standoff; it reflects a deeper question about national priorities and how far the United States is willing to go to sustain its social commitments. Programs like Medicaid now stand at the center of that divide, testing whether a nation built on collective security can continue to guarantee care for its most vulnerable while managing the weight of its cost.