WASHINGTON (TNND) — Republicans came away from the shutdown without having to give into Democratic demands to reopen the government, but the issue at the heart of the record-long impasse will continue into next year as midterm elections get closer and frustrations over the cost of living continue to mount.

Senate Democrats held out for weeks on a temporary stopgap to reopen the government over demands for Republicans to agree to extend expiring Affordable Care Act subsidies as part of a deal to end the shutdown but were ultimately only able to secure a promise of a vote on them later this year.

Without an extension, premium costs for thousands of Americans will soon skyrocket as open enrollment begins and next year’s midterms come into focus. The cost of living is already a potent political issue and has been a primary driver in voting choices over the last two years with inflation still running hot and increased costs for all kinds of day-to-day expenses.

An analysis by health care research nonprofit KFF found the average cost enrollees on subsidies will pay for premiums will double on average without an extension. The Congressional Budget Office estimates the rising prices will cost 2 million Americans health insurance next year. Extending them would be tremendously expensive at nearly $350 billion over the next decade, according to the CBO.

Trump made lowering costs a primary talking point on the campaign trail and has made some moves since returning to office on health care, like deals on lowering prescription drug prices, but a broader plan to replace or repair the issues with the Affordable Care Act have been more elusive.

He has recently suggested that Republicans should seek a new plan to send the funds directly to policyholders for health savings accounts, though details on such a plan remain hazy and its support among lawmakers is uncertain.

“We want a health care system where we pay the money to the people instead of the insurance companies,” Trump said Monday in the Oval Office. “We’re going to be working on that very hard over the next short period of time.”

Trump and Republicans have spent years criticizing the Affordable Care Act with claims it is a poor use of taxpayer funds and drove up the costs of health care rather than helping them decline, but they have not yet come up with an alternative system. An effort to repeal the law notoriously failed during Trump’s first term in office, and Republicans continue to be split on what the best approach on the issue is.

“Forcing health care to the top of the agenda — partly through circumstances, partly through the messaging of the shutdown — also exposes the vulnerability within the Republican Party that even though they've been campaigning on being against the Affordable Care Act for 15 years, they've never decided on what their alternative would be,” said Chris Devine, an associate professor of political science at the University of Dayton.

The politics surrounding the issue are complicated and sensitive for Republicans. Despite issues with the ACA, it has become broadly popular on both sides of the aisle by giving people who otherwise would not have coverage access to insurance and forcing insurance companies to cover preexisting conditions.

Last week’s elections that resulted in widespread Democratic gains in states across the political spectrum were decided in races centered around the cost of living. Polling over the last several months has found it to be top of mind for voters who are increasingly turning their frustrations toward Trump and Republicans in control of Congress after focusing them on Democrats in 2024.

The debate will continue even after the shutdown is over, particularly later this year when the Senate holds a vote on extending the subsidies. It is likely to fail as some Republicans have argued Congress should let them expire and GOP opposition to ACA, which may provide Democrats with an opening to attack Republicans on an issue the party has an advantage on and keep it in the spotlight during campaign season.

“One thing Democrats have done by attaching the shutdown argument to these Obamacare subsidies in particular, is to help clarify for voters where the parties stand on it, and even more so if they actually get a vote,” Devine said. “They've succeeded in putting on the political agenda an issue that has traditionally worked in their favor and very well might in this instance.”

House Democrats are taking steps to force a vote on a three-year extension of the expiring subsidies through a discharge petition, which allows any member to bring a bill to the floor for a vote if they can gather 218 signatures. It’s unclear whether Democrats will be able to get enough Republican support to meet the signature threshold, but it is another example of Democrats trying to keep the issue at the forefront.