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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

Updated 14 mins ago - World

Myanmar's deposed leader Aung San Suu Kyi sentenced to 4 years in prison

An anti-coup protest in Yangon, Myanmar.Photo: Hkun Lat/Getty Images

A Myanmar court sentenced the country's ousted leader, Aung San Suu Kyi, on Monday to four years in prison on charges of "inciting public unrest" and breaking COVID-19 protocols, per the New York Times.

Why it matters: It's the first of several verdicts that could result in the 76-year-old Nobel laureate being imprisoned for the rest of her life.

2 hours ago - World

Pope Francis denounces European governments' migrant response

Pope Francis adresses refugees at the Reception and Identification Centre (RIC) in Mytilene on the island of Lesbos on Sunday. Photo: Louisa Gouliamaki/Pool/AFP via Getty Images

Pope Francis criticized European countries' response to migrants and asylum seekers during his visit to a refugee camp on the Greek island of Lesbos Sunday.

Why it matters: The pope said "migration is a humanitarian crisis that concerns everyone," but little had changed in the global response to displaced peoples since his first visit to Lesbos five years ago, per a transcript of his remarks. "Human lives, real people, are at stake. ... let us stop this shipwreck of civilization!"

Chris Cuomo accuser: On-air "hypocrisy" spurred report

Journalist Chris Cuomo. Photo: Gilbert Carrasquillo/GC Images

A woman who accused fired CNN journalist Chris Cuomo of sexual misconduct said Sunday she decided to come forward after learning of his comments about women who made similar accusations about his brother. He denies her allegations.

Why it matters: Her attorney Debra Katz said in a statement that she heard "the hypocrisy" of his on-air words about his brother, former New York Gov. Andrew Cuomo, and was "disgusted by his efforts to try to discredit these women," so "retained counsel to report his serious sexual misconduct against her to CNN."

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