Ms Verstegen and her husband both work for a small business as fitness trainers, meaning they have to pay for their own plan. The Wisconsin parents of two have saved an estimated $800 (£601) a month on their health insurance through Affordable Care Act, also known as Obamacare, premium tax credits. Set to expire at the end of the year, the federal subsidies are now at the heart of the battle over the US shutdown. Democrats will not back a spending deal that reopens the government unless Republicans renew the subsidies. Ms Verstegen and others are watching anxiously, wondering what kind of financial consequences they would face if a deal can't be reached. "Everything's getting more expensive now anyway, and this would be another major hit for our family," she said.

Health policy experts say time is running out to prevent millions from losing their health insurance because the price hikes will make it unaffordable. The tax credits were first introduced through former President Barack Obama's Affordable Care Act (ACA) in 2014 and then expanded during the Covid pandemic. Some Americans could see their monthly cost of insurance - also known as a premium - rise by hundreds of dollars on 1 November, said Leighton Ku, a health policy professor at George Washington's Milken Institute School of Public Health. "If you are one of the 20 or so million people who's getting your health insurance through the marketplace, if you're about to see prices on average double, that's a big deal," he said. "It's going to be too late real soon."