Ending ACA subsidies could affect 2 million chronically ill
Add Axios as your preferred source to
see more of our stories on Google.
Illustration: Gabriella Turrisi/Axios
A decision by Congress to let enhanced Affordable Care Act subsidies expire next year could leave 2 million people with chronic conditions uninsured, a new analysis from consulting firm Oliver Wyman shows.
Why it matters: The fate of the subsidies is shaping up to be one of the biggest health care issues facing the next Congress.
- Democrats on Wednesday introduced legislation to permanently extend the aid — a long shot, considering it would increase the deficit by $335 billion over a decade. But a short-term extension could be in the cards, especially if one party doesn't control the White House and Congress.
Catch up quick: The premium tax credits were enacted during the pandemic and extended to the end of 2025 via the Inflation Reduction Act.
- The Congressional Budget Office has estimated ACA marketplace enrollment would drop from an estimated 22.8 million in 2025 to 18.9 million the following year if the enhanced subsidies expire.
- Middle-income marketplace enrollees with incomes just above four times poverty — or $60,240 this year — would in many cases be priced out of health insurance coverage, per KFF.
What they found: The Wyman analysis for Blue Cross Blue Shield Association, which is part of the coalition Keep Americans Covered, focused on 8.3 million individuals in the ACA market with arthritis, asthma, cancer, cardiovascular disease, COPD or diabetes. It concluded about one-quarter, or 2 million, would leave the market by 2027 if the enhanced subsidies expire.
- Enrollees with asthma are projected to leave at the highest rate (30%).
- They project those enrollees with chronic conditions who become uninsured will see an annual increase in health care costs between 17% and 44% of their annual household income, or as much as $10,700.
People with pre-existing conditions have become an overwhelmingly sympathetic group in political debates over the last decade.
The other side: Republicans have argued the enhanced subsidies cost taxpayers too much and incentivize fraud. A report from the Paragon Institute estimated millions might be misstating their incomes to get richer subsidies.
