Shutdown Poker – How Trump Gambles with the Health of Millions

It is once again one of those nights in Washington in which democracy threatens to break under its own paralysis. Hours before the deadline the US government is facing a partial shutdown because Congress and the president cannot agree on a budget. What sounds like routine – after all, American politics has a long tradition of budget battles – is in truth a risky game on the backs of millions of people. This time it is not about wall building or abstract austerity packages but about the core of the American welfare state: affordable health insurance. The starting point is clear: Democrats want to extend the expanded subsidies for health insurance under the Affordable Care Act (ACA) introduced in 2021. Without these subsidies, the price caps for around 24 million insured will expire at the end of the year. The result would be skyrocketing premiums that would be unaffordable for many families. Republicans are blocking and claim the subsidies are a gateway for illegal migrants – a claim that has long been refuted by fact checks. Not a single undocumented immigrant receives these subsidies. Yet the lie is repeated again and again because it has political effect.

Trump, who in his second year after returning to the White House still likes to present himself as a "negotiator," has summoned the leadership of Congress to the Oval Office: Mike Johnson, the Speaker of the House, John Thune, the Senate Majority Leader, and the Democratic opponents Chuck Schumer and Hakeem Jeffries. A historic meeting? More like a theater play. While Schumer and Jeffries point to the seriousness of the situation, Trump posts a manipulated video just a few hours later that is meant to ridicule the Democrats – complete with cartoon sombrero and mariachi music. What should have counted as negotiation ends as a meme battle online. The consequences of a shutdown, however, are anything but virtual. Hundreds of thousands of federal employees face forced leave without pay, many could even be laid off. In air safety the flight operations would be maintained but without pay, which in a system already plagued by staff shortages adds further risks. In Oklahoma City, where the only school for trainee air traffic controllers is located, classes would have to be suspended – a severe setback in a field that already suffers from 3,000 open positions.

The health care system itself is also affected. Medicare and Medicaid will technically continue, but staff reductions threaten delays in processing and payments. Even more severely hit is top research: the National Institutes of Health would have to send home three quarters of its staff, new studies would be stopped, patients would no longer have access to urgently needed experimental therapies. In the laboratories expensive research projects would literally decay. At the Centers for Disease Control and Prevention (CDC) more than half of the employees face forced leave – a risky state in a world where the next epidemic can break out at any time. FEMA, the disaster protection agency, would remain operational for acute missions, but the allocation of aid funds and insurance would be blocked. New mortgages in flood-prone areas could not be completed because the federal flood insurance is shut down. Even food safety inspections by the FDA would be restricted, inspections postponed, increasing the risk of food scandals.

But while federal agencies prepare for shockwaves, Wall Street shrugs its shoulders. The Dow Jones rises to a new record high, investors point to earlier shutdowns that mostly had short-term effects. Analysts recall that stock prices often even gained in the past. But this time it could be different: because Trump and his budget director Russell Vought have hinted that the president wants to use the crisis to systematically shrink the state apparatus – not just pauses but real mass layoffs. This would make the shutdown not only a short-term pothole but a tectonic shift in the structure of the state.

The parallels to the past are striking. In the winter of 2018/19 Trump held the country in a stranglehold for 35 days because he wanted money for his border wall. Back then he only gave in when airports were paralyzed and even conservative lawmakers sounded the alarm. Today it is not about concrete but about health. Again millions of citizens stand as hostages in a political power play. While Democrats are playing for time and hoping for concessions, Trump cements his reputation as a chaos president. With threats, with mocking videos, with the announcement of "cutting things they love," he pours oil on the fire. A president who acts like a troll online while the country heads toward paralysis – that is the disturbing finding of these hours.

That it is precisely health care that becomes the bargaining chip is more than symbolism. It shows how much social security in the US has become a negotiating mass. For Trump and his allies it is about power, for millions of families it is about whether they can still pay for their insurance in the coming year. Washington is playing poker – and the stakes are not chips on the table but the lives of people.

To be continued .....