The federal government shutdown hurts the South a lot more
When it comes to health care, which is what the federal government shutdown is about, some states will bleed. The South will gush.
In the days and weeks to come, as the federal government shutdown lingers, the political parties in America will huddle in back rooms and look at the numbers.
The point of these meetings will be to assess who's getting blamed for this shutdown, which marks the 15th time since 1981 that Republicans and Democrats have failed to reach an agreement on keeping the government open.
It's a political debate, one that will probably determine which side caves in the end. But there's no real debate about who the shutdown hurts more, or who has more at stake.
It's the South.
The irony is rich, and uniquely American.
Who needs the federal government more?
"The federal government is our servant, but not our master," Thomas Jefferson, perhaps the father of Southern "states' rights" rhetoric, once wrote.
But the federal government, it seems, has been doing a lot of serving in the South in modern times. And while conservative voters in the region might not like the feds, it's clear that not having the feds would hurt more.
Where our federal dollars go changes a lot year over year because of natural disasters, grants, and who's in power, but generally it is rural, conservative-leaning states—and especially states in the South—that are the most dependent financially.
They tend to put in less in taxes to the feds than they get back in funding, compared to big, blue states like New York and California, where the reverse is true.
And when it comes to health care, which is what this shutdown is about, the South especially has a lot more to lose.
As the nonpartisan Kaiser Family Foundation (KFF) reported last week, more than 3 in 4 enrollees in the Affordable Care Act (or "Obamacare") marketplace live in states that Trump won in 2024. They are benefitting from federal subsidies that Democrats passed during the COVID-19 pandemic to help people get health insurance.
This shutdown is chiefly about extending those subsidies beyond this year. Democrats want that. Republicans don't.
Trust in the federal government is generally lower among Republicans and conservatives, and they dominate states that President Trump won in 2024. Logic would tell you these voters would be unmoved by a shutdown, but that logic belies how much more these voters will lose.
Billy Ball
In the coming days and weeks, unless Republicans budge on subsidies, tens of millions of Americans will be receiving notifications that the cost of their healthcare will explode in 2026.
Some states will bleed. The South will gush. People will get sicker and they'll die. That's not hyperbolic. It's what happens when people don't see doctors.
The number of people on the ACA marketplace has doubled since expanded federal subsidies were offered. More than half of that growth comes from Florida, Texas, Georgia, and North Carolina, the KFF reported. In Texas, Louisiana, Mississippi, Tennessee, Georgia and West Virginia, ACA enrollment has tripled in the last five years.
Nearly all of the enrollees in Florida, West Virginia, Alabama, and Mississippi are getting subsidies.
It is an overwhelming statistical argument. That the gap between reality and the political debate is so large is a trenchant sign of our times.
There is a way out of the shutdown
The path forward might surprise you.
While President Trump might be insulated from the pain of the shutdown and the loss of ACA subsidies—both politically and personally—the politicians who have to win elections every two years in red states aren't.
That's why you're seeing Southern and midwestern members of Congress, like Georgia Rep. Marjorie Taylor-Green and Missouri Rep. Josh Hawley, respectively, talking about health care right now.
“I’m absolutely disgusted that health insurance premiums will DOUBLE if the tax credits expire this year,” Greene wrote on X Monday.
Having health insurance and seeing a medical provider is popular it turns out. And to twist a phrase that's usually about money, having health care might not be everything, but not having it can be.
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That's not to say what happens next is predictable. President Trump has a unique faculty for getting people to vote for things that, at least in theory, hurt them.
But the members of his party who have to win elections next year—while health care premiums are going through the roof and the economy sputters from a self-inflicted federal shutdown—won't enjoy the same benevolence.
They will have to not talk about the thing that many of their voters will be talking about the most. They'll need all the luck they can get.
And the South, which has spent generations wedded to an idea of a very small government, will be poised to find out, again, the price of those principles.
The Living South was created by North Carolina journalist Billy Ball in 2025. It centers on the most interesting stories and people in the American South. Share this story with your friends and help The Living South grow.
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