Sue Dinsdale is the Executive Director of Iowa Citizen Action Network and the State Lead for Health Care for America NOW. This time, disagreements in Congress over health care costs and access are preventing an agreement that would keep critical services going without interruption. Nearly half of Americans get health insurance coverage through Medicaid, Medicare, or buy private insurance through a state or federal ACA marketplace. For example, health care costs will quadruple for individuals making just $39,142 a year, as well as families of four with combined incomes of around $80,000 a year. Ultimately, they decide whether the cost of health care goes up and down, and whether the government stays open.