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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

Scoop: Gina Haspel almost resigned over plan to install Kash Patel as CIA deputy

Photo: Win McNamee/Getty Images

CIA Director Gina Haspel almost resigned in early December after President Trump cooked up a hasty plan to install loyalist Kash Patel, a former aide to Rep. Devin Nunes (R-Calif.), as her deputy, according to three senior administration officials with direct knowledge of the matter.

Why it matters: The revelations stunned national security officials and almost blew up the leadership of the world's most powerful spy agency.

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Health: Coronavirus deaths reach 4,000 per day as hospitals remain in crisis mode — CDC warns highly transmissible coronavirus variant could become dominant in U.S. in March.
  2. Politics: Biden says, "We will manage the hell out of" vaccine distribution — Biden taps ex-FDA chief to lead Operation Warp Speed amid rollout of COVID plan — Widow of GOP congressman-elect who died of COVID-19 will run to fill his seat.
  3. Vaccine: Battling Black mistrust of the vaccines"Pharmacy deserts" could become vaccine deserts — Instacart to give $25 to shoppers who get vaccine.
  4. Economy: Unemployment filings explode againFed chair: No interest rate hike coming any time soon —  Inflation rose more than expected in December.
  5. World: WHO team arrives in China to investigate pandemic origins.

NRA declares bankruptcy, says it will reincorporate in Texas

Wayne LaPierre of the National Rifle Association (NRA) speaks during CPAC in 2016. Photo: Saul Loeb/AFP via Getty Images

The National Rifle Association said Friday it has filed for Chapter 11 bankruptcy and will seek to reincorporate in Texas, calling New York, where it is currently registered, a "toxic political environment."

The big picture: The move comes just months after New York Attorney General Letitia James filed a lawsuit to dissolve the NRA, alleging the group committed fraud by diverting roughly $64 million in charitable donations over three years to support reckless spending by its executives.

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