Democrats face a potential pre-election “political time bomb” on an issue they had hoped would provide a boost with voters: the expansion of Affordable Care Act coverage resulting from increased subsidies.
Politico’s Adam Cancryn and Megan Messerly report that Democrats now worry that the more generous subsidies enacted as part of the March 2021 American Rescue Plan Act will expire as scheduled at the end of the year, leading to premium hikes that could affect some 13 million Americans and undo one of President Joe Biden’s key health care achievements. “And in a painful twist for a White House already struggling to contain anger over rising household costs,” Cancryn and Messerly note, “voters would begin receiving notices about their premium increases in October — around the same time they’re starting to cast their midterm ballots.”
The increased subsidies have helped drive Affordable Care Act enrollment to record highs in 2022, as more than 14.5 million people signed up for insurance plans under the law, a 21% increase over last year. And while Democrats hope to extend the higher subsidies — and the coverage gains they’ve produced — they acknowledge, according to Politico, that the only way to do that is to reach a long- elusive deal with Sen. Joe Manchin on a broader budget reconciliation bill: “Maintaining the subsidies is projected to cost tens of billions of dollars per year. And with Republicans uniformly opposed to continuing them, tucking an extension into the broader partisan bill is the last available option before the midterms.”
Healthcare headaches: The potential increased costs or loss of affordable coverage for millions of Americans adds to a similar concern that health care experts have been warning about for months: The official end of the pandemic-related public health emergency, whenever it comes, will also mean the end of a rule that prohibited states from purging their Medicaid rolls, and an accompanying increase in federal Medicaid funding. Once states start reviewing the eligibility of Medicaid enrollees, millions of beneficiaries could see their coverage dropped.
The bottom line: The Affordable Care Act subsidies only add to the pressure on Democrats to try to put together a budget reconciliation bill — and do it quickly, before insurers start setting their rates for next year. That means sewing up a deal with Manchin, who Politico says has been characteristically cagey about the issue. “Though he’s supported expanding Obamacare in the past, Manchin has so far been noncommittal about adding the subsidies into an eventual bill.”