Subsidies have increased the membership of the Affordable Care Act. It’s preparation for a potential fight

Health insurance subscriptions under the Affordable Care Act (ACA) jumped nearly 2 million in the latest enrollment period that ended in mid-January to 16.3 million.

These successes indicate that the program known as Obamacare is becoming successful despite repeated attempts by Republicans to shut it down.

It also suggests that subsidies provided to the program through two sweeping pieces of legislation initiated by President Biden had an impact. The subsidy was established by the American Rescue Plan in 2021 and subsequently expanded under the Inflation Reduction Act.

“This really speaks to the improved availability of ACA Marketplace plans. Expanded subsidies have made ACA Marketplace plans much more accessible and attractive to people,” Krutika Amin, deputy director of the Kaiser Family Foundation (KFF), told The Hill.

A potential future problem for the Affordable Care Act is that these critical subsidies expire in 2025 and Congress will need to renew them to continue.

Both the White House and Democrats in Congress have called for the subsidy to be made permanent, but Republicans are likely to oppose the effort.

This creates a battle in next year’s race for the White House and a majority in Congress.

Republicans on the House Budget Committee recently proposed cutting these subsidies to help solve the national debt problem. Such a change could affect future school enrollment, tarnishing the expanded access to health care that the Biden administration has listed as one of its hallmark achievements.

In its proposal, the House Budget Committee proposed limiting ACA subsidies to 400 percent of the poverty line and below, essentially returning to the original standards set by the ACA. The group calculated that “overpayment reimbursement” could save the government $65 billion.

Whether the majority of the Republican Party will actually move forward with such a proposal is the real question, according to some analysts.

“I am skeptical about this precisely because the budget committees do this every year. This does not necessarily mean what the Republican majority would generally support. It’s a starting point for sort of a discussion,” Joseph Antos, a health policy analyst at the conservative American Enterprise Institute think tank, told The Hill.

Antos noted that the Republican Research Committee did not mention a cut in ACA premium subsidies in its proposed alternative 2023 budget, with the plan primarily focusing on regulatory changes to the program.

Ending subsidies would be politically fraught, especially given the wider use and popularity of the program.

“The old saying goes that if you give someone a right, you can’t take it back. And that’s what ACA is,” Antos said. “It is very difficult for a politician to actually go for the reduction of everything that directly affects the voters. It doesn’t really matter if you think the people who benefit the most are more likely to vote Democrat or Republican. It leaves a bad taste in everyone’s mouth.”

KFF’s Amin noted that the revenue cap for subsidies proposed by Republicans in the House of Representatives would set the cut-off at just over $54,000 in 2023.

“If that happens when ACA subsidies are again capped at this income level, then some people — especially middle-income people and the elderly — will have to pay a lot more for simple market plans,” Amin said.

Amin gave the example of a 60-year-old man earning about $55,000 a year. With current subsidies, such a person would pay about 8 1/2 percent of their income for Silver Health Plan, a mid-tier plan available through the Marketplace.

“If the GOP proposal to limit subsidies … is passed, in some states a 60-year-old citizen will have to pay on average more than 20 percent of his income,” Amin said.

While he didn’t touch on that particular proposal, Biden made it clear in his State of the Union address last week that he would veto any Republican legislative effort to radically change the healthcare landscape, including federal access to abortion and potential cuts. in Medicare.

In addition to subsidies, administrative officials and health stakeholders also attribute the increase in enrollment to a collaborative outreach and awareness effort.

Liberal health advocacy group Protect our Care cited the administration’s investment in the ACA Navigators program as another reason for the increase in enrollment. Navigators are essentially ACA enrollment advisors tasked with raising awareness of Marketplace plans and helping consumers prepare their apps.

“The rate of uninsured services in the country is at its lowest level ever,” Protect our Care said in a statement. “We are finally starting to unlock the true potential of the Affordable Care Act, and you can see that reflected in the number of registered members. The lesson here is that the American people want us to continue to push these policies until we provide everyone with the care they need to thrive.”

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A spokesman for the Centers for Medicare and Medicaid (CMS) echoed the sentiment, saying coverage rates have grown to “unprecedented magnitude and scale” in the past year.

“Participant reach included investments to reach several audiences that have lower access to health care. For example, CMS is partnering with cultural marketing experts to run effective campaigns for African American, Hispanic and English Latino, and Asian American and Pacific communities in multiple languages,” the spokesperson said.

CMS has invested almost $100 million in grants to 59 Navigator organizations for this year’s enrollment period, another record amount, according to an agency spokesperson.

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