Illustration: Aïda Amer / Axios
Pressure to renew expiring enhanced Affordable Care Act subsidies is likely to ramp up this fall as notices of 2026 premium increases go out and consumers get their first warnings that huge rate hikes could be coming.
Why it matters: Backers of renewing the enhanced tax credits are hoping that the sticker shock could motivate undecided lawmakers to get behind a short-term reauthorization to avoid an uproar over premium increases in an election year.
What they're saying: "This is going to rain starting in October; people are going to start getting these notices," said Leslie Dach, chair of the Democratic-aligned group Protect Our Care. "And it comes right to your doorstep, right to your mailbox."
- Republicans in Congress, he said, are not "going to do anything until they see the light of their constituents' eyes here … so the most important thing is to be sure people know what's going on."
The big picture: Out-of-pocket premium costs for over 20 million enrollees in the ACA marketplaces will increase by an average of 75% if the enhanced subsidies expire at the end of this year, according to KFF. The CBO also finds 4.2 million more people would become uninsured over a decade.
- That puts Republicans in a bind heading into the midterm elections: stuck between resisting an expansion of the ACA and the fear of steep health cost increases for their constituents.
- Although some GOP lawmakers are open to a deal on an extension, there's substantial concern over the projected $335 billion cost over 10 years — and the often expressed sentiment that the subsidies are a handout to insurance companies.
Between the lines: When exactly people will get notices about premium increases for next year depends in part on whether they are in one of the 20 states that run their own ACA marketplaces, where notices typically go out earlier.
- Insurers at a minimum must send notices before Nov. 1, when sign-ups for next year begin.
- Those notices tend not to have completely up-to-date individualized information, so many people likely will not see exactly how much more they will pay.
- But this year insurers are in discussions about how best to make clear that the enhanced subsidies are expiring. They're likely to include language informing people and telling them to check the healthcare.gov portal for the exact premium increase.
- "I think that this could turn into quite a political issue for an important voting bloc, and frankly, a constituency that the data suggests swung more heavily toward Republicans in the last elections," said Ceci Connolly, CEO of the Alliance of Community Health Plans. "This will hit pocketbooks directly."
The other side: Brian Blase, president of Paragon Health Institute and a former Trump administration health official, said that when the enhanced subsidies first passed in 2021 they were meant as a "temporary COVID measure," and that it was Democrats who set them to expire.
- "How are they going to come up with that amount of money" to pay for an extension? he asked. "I mean, that's a huge chunk of change, and these are subsidies that go directly to health insurers."
