Illustration: Sarah Grillo/Axios
Freshmen Republican senators who could play a big role in deciding whether to extend enhanced ACA subsidies appear to be only vaguely familiar with the issue and what it could mean for health insurance in their states.
Why it matters: Although conventional wisdom is that Republicans will let the enhancements expire at the end of this year, voters in states President Trump carried could have the most to lose.
- Some of the biggest enrollment increases in ACA marketplaces have been in red states that didn't expand Medicaid. People with household incomes from 100% to 138% of the federal poverty line are eligible for subsidized marketplace coverage in those states.
- The CBO estimates that if the enhanced subsidies expire, 3.8 million people on average could become uninsured, and premiums could rise 7.9% on average, from 2026 to 2034.
What they're saying: Senators displayed only passing familiarity with the ACA subsidies when queried by Axios.
- "I'm going to have to do some work on understanding what the implications of all that is before I take a position on it," said Sen. Jon Husted. "In time, I'm sure I'll have an opinion."
- "That's something that we've got to really look at and study, and understand it more," said Sen. Bernie Moreno.
"I'm not going to dig into that now, and that's a lot to answer in just a passing thing," said Sen. Dave McCormick. "I'm going to pass on questions right now."
- "I don't know," said Sen. Jim Banks, when asked his thoughts on the subsidies on the way to the Senate floor. "I'm happy to chat about that sometime soon."
- Sen. Ashley Moody said any questions on the subsidies would have to be sent to her office.
Others acknowledged the political difficulty of a subsidy cliff without offering concrete solutions.
- "That's really tough stuff," said Sen. Jim Justice. "If we get to that and everything, then you know, all of us will have to evaluate. That's fair."
- Asked about possible coverage losses, Moreno said Republicans would make contingencies.
- "If anything, we're going to make health care a lot less expensive and a lot higher quality for Americans. We're going to work through what the best plan is to make that happen," Moreno said. "We're working on it. We have plenty of time."
- The offices of Sens. John Curtis and Tim Sheehy didn't provide a request for comment by deadline.
Reality check: Most of the new senators have only just settled into their offices and can't be expected to be instantly up to speed on the policy, especially with a string of Trump administration nominees awaiting confirmation.
- And the cost of extending the subsidies would be steep: CBO has projected that a permanent extension of the subsidies would cost $335 billion over 10 years.
The other side: Many conservatives argue that the enhanced subsidies should expire, saying that individuals with higher incomes are wrongly benefiting from the low-cost insurance.
- Paragon Health Institute, which has recently fed several health policy experts into the new Trump administration, has pushed out policy proposals that call for letting the subsidies expire and cracking down on fraud in the program.
- It's unclear where Trump stands on the issue, though he railed against the ACA during the 2024 campaign.
Between the lines: Key senators like Senate Finance Chair Mike Crapo and Senate HELP Chair Bill Cassidy previously didn't rule out the possibility of ACA subsidies being extended in reconciliation.
- And Sen. Lisa Murkowski, a key GOP swing vote, recently told the Alaska Beacon that she supports extending the ACA premium tax credits because of the high cost of health insurance for Alaskans.
The bottom line: The more divided Republicans are on how to get reconciliation done, the better the bet that the subsidies won't be included.
