- David Nather
- Aug 1
Map: Who loses if Trump cuts off health insurer payments
We could get a decision from Trump today on whether the administration will keep paying insurers for their cost-sharing reduction subsidies to low-income people. A few things to keep in mind if he stops the payments:
- Insurers have to keep providing the subsidies anyway — they just won't be reimbursed. That's why they'd respond by raising premiums for next year by as much as another 20%.
- In Iowa, Medica — the last ACA insurer standing — says it would raise its premiums another 12% to 20% for next year if the payments end, per the Des Moines Register.
- About 5.9 million people get the subsidies — about 57% of everyone who's enrolled in ACA private insurance coverage, according to the Centers for Medicare and Medicaid Services.
- They're heavily concentrated in red states, and especially in the south, as you can see from this map by our visuals editor, Lazaro Gamio. (We ran this map back in April, and now that the payments are under threat again, we thought it was time for an encore.)
- The move would end up costing the federal government more money, rather than saving money, because the ACA tax credits would adjust to cover the higher premiums. The Kaiser Family Foundation predicts a net increase of $2.3 billion in federal costs next year.
- But anyone who doesn't qualify for the tax credits would have to eat the extra costs.
- The White House will point out, correctly, that Congress didn't fund the payments and that it could end the uncertainty at any time by doing so.
- Now that the repeal bill — which would have funded the payments for two years — has collapsed, most Republicans won't want to provide the funding on its own. But some are reluctantly acknowledging they may have no choice. "I think we're going to have to do that," Senate Finance Committee chairman Orrin Hatch told Reuters.