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We’ve been here before: congressional Democrats and Republicans sparring over the future of the Affordable Care Act.

But this time there’s an extra complication. Though it’s the middle of open enrollment, lawmakers are still debating whether to extend the subsidies that have given consumers extra help paying their health insurance premiums in recent years.

The circumstances have led to deep consumer concerns about higher costs and fears of political fallout among some Republican lawmakers.

According to a KFF poll released in December, about half of current enrollees who are registered to vote said that if their overall health care expenses — copays, deductibles, and premiums — increased by $1,000 next year, it would have a “major impact” on whether they vote in next year’s midterm elections or which party’s candidate they support.

For those caught in the middle — including consumers and leaders of the 20 states, along with the District of Columbia, that run their own ACA marketplaces — the lack of action on Capitol Hill has led to uncertainty about what to do.

In general, Democrats want to extend the life of the more generous subsidies, created in response to the covid pandemic. Those are set to expire at the end of the year. Republicans are split, with many balking at the cost of a straightforward extension, as well as the policy and political implications that might come with a vote to buttress Obamacare, which many have long viewed as public enemy No. 1.

Meanwhile, the clock is ticking for shoppers. People need to choose their ACA plan before Dec. 15 for coverage to begin Jan. 1. Open enrollment continues in most states until Jan. 15.

The marketplaces, too, must have contingency plans in case Congress intervenes. These adjustments could take days or weeks.

“We have a plan on the shelf” to go update the website, including notifying consumers of any changes, said Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, a state-based ACA insurance marketplace.