Sens. Lamar Alexander and Patty Murray. Photo: Tom Williams/CQ Roll Call via Getty Images

There would be more losers than winners if Congress funds the Affordable Care Act's cost-sharing subsidies, a weird twist resulting from how insurers responded to President Trump cutting off the payments last year.

Why this matters: The Senate is expected to vote on a bill, crafted last year by Sens. Lamar Alexander and Patty Murray, that would fund the subsidies — as almost every expert suggested back then. But now, passing the same bill would make coverage less affordable for more people than it would help.

What we found, using 2017 data: Out of 9,201,805 healthcare.gov enrollees, here's how many would win and lose if the insurer subsidies were now funded:

  • Winners: 682,712 unsubsidized exchange enrollees enrolled in middle-of the-road "silver" plans
  • Losers: 1,621,325 enrollees who receive premium subsidies and don't have silver plans
  • Likely losers: 1,706,780 enrollees with silver plans and incomes between 200%-400% of the federal poverty level.

How it works: After Trump cut off federal funding for the ACA's cost-sharing subsidies, insurers raised their premiums to make up the difference. Most of them loaded the whole increase onto the premium for "silver" plans. Those are the only plans that offer the cost-sharing reductions in question, and they're also used to calculate the separate subsidy each person can use toward their premiums.

  • As premiums rose for "silver" plans, everyone got a bigger premium subsidy.

Losers: People in gold and bronze plans, whose subsidies are now covering more of their monthly premiums. This would reverse if cost-sharing payments resumed and the size of the premium subsidy dropped.

Winners: People enrolled in silver plans, who make too much to qualify for a premium subsidy.

  • These people felt the brunt of the premium hikes because they weren't getting any federal assistance. If the premiums go down because CSR payments are made, they pay less.

How we arrived at these numbers: With a ton of help from the Brooking Institution's Matthew Fiedler, and using some assumptions:

  • We assume insurers in every state would load the relevant premium increases onto subsidized silver plans. (Some didn't last year.)
  • We used Centers for Medicare & Medicaid Services data on 2017 plan selections in states using healthcare.gov. In 2018, fewer people enrolled in the marketplaces. Obviously, we don't know how many people will enroll in 2019.

Go deeper

Updated 18 mins ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Global: Total confirmed cases as of 9 a.m. ET: 33,138,963 — Total deaths: 998,380 — Total recoveries: 22,953,639Map.
  2. U.S.: Total confirmed cases as of 9 a.m. ET: 7,116,455 — Total deaths: 204,762 — Total recoveries: 2,766,280 — Total tests: 101,298,794Map.
  3. States: 3 states set single-day coronavirus case records last week
  4. Health: The childless vaccine — Why kids get less severe coronavirus infections.
  5. World: India the second country after U.S. to hit 6 million cases
28 mins ago - Technology

Exclusive: Where Trump and Biden stand on tech issues

Photo illustration: Aïda Amer/Axios. Getty Images photos: Win McNamee and Saul Loeb/AFP

Joe Biden has laid out a more concrete tech agenda whereas President Trump has focused on tax cuts and deregulation while criticizing tech firms for anti-conservative bias. That's according to a side-by-side analysis of the two candidates' tech records by the Information Technology & Innovation Foundation shared exclusively with Axios.

Why it matters: The tech industry needs to prepare for either four more years of Trump's impulsive policy approach or for a Biden administration that's likely to be critical of tech but slow to take action.

Dion Rabouin, author of Markets
2 hours ago - Economy & Business

Big Tech's share of the S&P 500 reached record level in August

Expand chart
Reproduced from The Leuthold Group; Chart: Axios Visuals

The gap between the weighting of the five largest companies in the S&P 500 and the 300 smallest rose to the highest ever at the end of August, according to data from the Leuthold Group.

Why it matters: The concentration of wealth in a few massive U.S. tech companies has reached a scale significantly greater than it was before the dot-com bubble burst.

Get Axios AM in your inbox

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Subscription failed
Thank you for subscribing!