Time crunch poses obstacle to ACA talks
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It may already be too late to implement certain changes Republicans are insisting on as a condition for renewing to Affordable Care Act subsidies, further casting doubt on any congressional deal to extend the financial aid.
Why it matters: GOP lawmakers have made clear that they need to see changes to the enhanced ACA tax credits at the center of the government shutdown fight in order to extend them.
- But insurers, states and other experts say some changes could already be impossible for next year, with ACA enrollment due to begin in less than two weeks, on Nov. 1. The subsidies are due to expire at year's end, absent further action.
What we're hearing: Extending the credits after Nov. 1 is still possible, experts say, but gets much harder if there are significant changes, such as capping eligibility at a certain income level or requiring recipients to make a minimum premium payment.
What they're saying: "I have zero confidence that there's enough operational time for systems and issuers to be able to implement changes, significant changes," said Jeanne Lambrew, a former key health adviser in the Obama White House and later a top health official in Maine.
- Sen. Mike Rounds (R-S.D.), one of the GOP senators more open to some form of subsidy extension, acknowledged that the implementation timeline poses a problem.
- "Good question, and that's why a lot of us started talking about it in July," Rounds told Axios, blaming Democrats for triggering the shutdown on Oct. 1.
- "When you have a shutdown that just kind of kills the discussions," he said.
Between the lines: One possible workaround would be for Congress to extend the enhanced subsidies unchanged for one year and then have GOP changes take effect in 2027. It's not clear if that would pass muster in the House and Senate.
- Some insurers are warning about implementation challenges in trying to make major changes for 2026.
- "Our recommendation would be [a] straight extension for 2026 so that you can get the tax credits updated immediately and get people covered," said an insurance industry source, speaking on the condition of anonymity to share private conversations. "Then, if Congress wants to make changes, those should apply in 2027 or later."
Devon Trolley, executive director of Pennsylvania's ACA marketplace, said "at this point in the calendar, the lowest risk option is an extension of the same framework that the enhanced tax credits have today."
- "Some changes might be not possible to implement if they structure it in a very different, very complicated way in the near term," she said. "But other changes might be."
An added complication is that there is no solution in sight for satisfying Republican demands that additional language be added preventing the subsidies from funding elective abortions.
The bottom line: Congressional Democrats have been urging Republicans to enter negotiations, saying time is running short, while the GOP counters that Democrats need to open the government first.
- "We can't do any of that if we're not negotiating," said Sen. Chris Murphy (D-Conn.) when asked about the time frame for changes to the tax credits.
- "We've always understood there's going to be a negotiation, but it's only Republicans that are boycotting those negotiations."
