As of midnight, we have been in a partial shutdown of the federal government because of an impasse in the U.S Senate over a continuing resolution to fund the government until Nov. 21. The measure cleared the Republican-controlled House on Sept. 19 on a vote of 217 to 212. In the Senate, under that chamber’s special rules, the measure needed 60 votes to pass, but Republicans do not have that number in their own conference and so need Democratic votes to pass the measure. Competing Republican and Democratic versions failed in the final hours before the shutdown deadline of midnight on Sept. 30, the end of the fiscal year.

What’s the holdup? Changes to Medicaid are involved, but the main issue is that Democrats insist that an extension of expiring subsidies for Affordable Care Act (Obamacare) health insurance premiums be included in the continuing resolution. Republicans promised to engage in a discussion of the ACA premium subsidies and other health-care-related matters at a later date. Democrats held out. No continuing resolution was passed by the deadline of midnight Tuesday looking into Wednesday, and now, on Wednesday, we’re in a partial government shutdown that could drag on.

Bravo, Senate Democrats! Do not give an inch in this fight; the outcome here is crucial to the health of about 24 million Americans.

The federal subsidies for premiums on health insurance purchased through the ACA marketplace were to have expired several years ago, but these subsidies were twice extended via major bills passed in Congress during the Biden administration. To be clear, these subsidies are funded by taxpayer money, and some critics of the program loudly disparage the subsidies as socialism. But they are no more socialistic than the federal government subsidies that are included in every Farm Bill to help keep American agriculture in business. Nor are they any more socialistic than the $28 billion fund set up during the first Trump administration to help farmers who lost export sales as a direct consequence of the tariff wars that Trump started.

As far as I am concerned, the federal subsidies for ACA health insurance premiums are a righteous use of public money.

And as for Republicans’ saying they are willing to discuss ACA subsidies at a later date but not now, that is a crock. The emergency is now. Annual open enrollment for health insurance begins on Nov. 1, but in a matter of days from now, health insurers will be sending their customers notifications about the premiums those companies will charge for coverage in 2026. To set their pricing plans for 2026, the companies need certainty now, not in two weeks or later.

The question of ACA premium subsidies must be resolved now, not later. If no extension of subsidies is passed in the short-term spending bill — or continuing resolution (so named because it continues federal funding at existing levels in the absence of a proper appropriations bill) — health insurance premiums for the approximately 24 million Americans now covered via the ACA will rise steeply. The consequence will be that millions of Americans will no longer be able to afford health insurance and will drop out of coverage.

One cannot reasonably forecast how many people now covered by insurance purchased through the ACA would give up the coverage because they decided they just could no longer afford it, but surely the number would be in the multiple millions. The great danger, of course, is that people with chronic ailments such as heart disease, diabetes, high blood pressure, respiratory diseases and various mental illnesses will suddenly stop taking their maintenance medications. Use your imagination. No good can possibly come of such a situation.

But despite the public harm caused unaffordable health insurance premiums, Republicans would have made progress on one of their cherished objectives: destroying the Affordable Care Act. You may recall the Republican reaction to the legislation when it was signed into law by President Barack Obama in March 2010, with then-Vice President Joe Biden being caught on a hot microphone telling Obama, “This is a big fucking deal!” Republicans were dead set against it, and I always thought that their opposition was in large measure rooted in racism.

The right-wing white Republican establishment despised Obama — not just for himself but also for what his election signaled about the future direction of the country — and that establishment recognized that a program that would help millions and millions of uninsured Americans to afford health coverage would be a legacy achievement for the nation’s first black president. The very thought of it incensed those Republicans no end, and they set out to destroy what was by then well known as “Obamacare.”

Enter this appalling man by the name of Donald Trump. In addition to his regular 2016 campaign boast that he would build a southern border wall for whose construction Mexico would pay, he repeatedly pledged to repeal the Affordable Care Act and replace it with something better. I do not recall that he ever clearly articulated what was wrong with the ACA, but he would produce something better than it, he declared.

When this malignant racist became president in January 2017, he began his legislative assault on the ACA, the proudest domestic work of his black predecessor, via his pet Republican conferences in the House and Senate. He failed, most spectacularly when Sen. John McCain — a Republican, we should remember — gave that famous thumbs-down on the Senate floor in July 2018, driving the fatal stake into the heart of the GOP’s best attempt at repealing Obamacare.

Republicans have not given up on their hope of seeing the death of Obamacare. What they have given up on is any pretense that they intend to offer an alternative. They never had one in the days of Trump 1.0 when they were pretending that they had such a plan; and there is no longer any talk of producing something better. Under Trump 2.0, the Republican agenda across the federal government is simply to dismantle and destroy, and nothing is being created that is not a tribute to the diseased ego of Mad King Trump.

So we return to the present test facing congressional Democrats. For leverage in the standoff, Trump has threatened to fire vast numbers of federal workers rather than furlough them during the shutdown, as would be normal. Democrats should ignore this threat. The ACA question is a red line from which they must not retreat. If they fold here, they will surrender any credibility and usefulness they could have had in the necessary resistance to the madman.