As the holiday recess approaches, it appears increasingly likely that Congress will exit Washington without extending the Affordable Care Act (ACA) health insurance subsidies. These enhanced subsidies for ACA marketplace plans are set to expire at the end of this year, resulting in dramatically increased premiums for millions of Americans. Many individuals are already reporting that the cost of their health plans could double or even triple without the support of these subsidies.
The deadline for enrollment in ACA exchange plans recently passed on Monday, and numerous subscribers now face the daunting decision of forgoing health insurance entirely due to unaffordable premiums. Despite the looming crisis, Congress has yet to unite on a plan to effectively address health care costs. Interestingly, public support for the Affordable Care Act remains robust, with polls indicating approval from voters across the political spectrum for extending these critical subsidies, initially enacted in 2021.
Efforts to advance a bipartisan measure to extend the subsidies have been ongoing among rank-and-file members on both sides of the Capitol. However, the only proposals that have been put to a vote thus far have been partisan—one supported by Senate Republicans and another by Senate Democrats—both of which failed to secure the necessary votes. This Wednesday, the House is expected to vote on a separate health reform package introduced by House Speaker Mike Johnson, R-La. While this narrow measure includes several conservative proposals, it does not address the impending expiration of the subsidies.
Top Democrats in the House are advocating for a standalone extension of the subsidies, similar to the plan previously proposed in the Senate. This extension would last for three years and would not include any accompanying reforms designed to attract Republican support. Four Senate Republicans did align with Democrats on this bill, including Susan Collins of Maine and Lisa Murkowski of Alaska, among others. Senator Josh Hawley of Missouri highlighted the urgent need for lower health care prices, emphasizing the impact on constituents.
Throughout the fall, Democrats have sought to expedite the extension of these subsidies, even withholding votes on government funding legislation, which resulted in a record-long government shutdown. Some Republicans have voiced concerns about allowing the enhanced subsidies to lapse. Representative Kevin Kiley, R-Calif., remarked that 22 million people should not bear the burden of Congressional inaction. A contingent of House Republicans is working on proposals to bypass leadership and force a vote on extending the subsidies, but it remains uncertain if these proposals will gain enough traction before the expiration date.
Interestingly, even conservative lawmakers like Representative Marjorie Taylor Greene, R-Ga., have begun to advocate for the continuation of subsidies despite previously opposing the ACA. Greene acknowledged that the reality of the ACA has evolved since its passage without any Republican votes. As the health care debate has persisted over the past 15 years, many Republicans have come to terms with the ACA’s permanence, shifting their rhetoric from "Repeal and Replace" to "Reduce and Repair."
Public opinion on the ACA has shifted dramatically, with recent surveys indicating broad support for extending the enhanced subsidies among Republicans, independents, and Democrats alike. In fact, many marketplace enrollees reside in Republican congressional districts, where small business owners and farmers are particularly affected by rising health care costs. Pollster John McLaughlin has noted that voters are more likely to support candidates who advocate for health care tax credits, reinforcing the political imperative for lawmakers to act on this issue.
The House is set to vote on Speaker Johnson's health care bill, which lacks provisions for extending subsidies. While some lawmakers hope that the recent failed partisan votes will reignite the pursuit of a bipartisan compromise, time is running short. With new premium rates scheduled to take effect in less than two weeks, the window for Congress to strike a deal and alleviate the impending price spikes is quickly closing.
As the debate surrounding the Affordable Care Act continues, stakeholders on both sides are keenly aware that the outcomes will have significant ramifications for millions of Americans seeking affordable health coverage.